MEDICARE: JOHN KNOX VILLAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	132-20	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770587040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN KNOX VILLAGE

Provider Business Mailing Address
First Line	:	400 NW MURRAY ROAD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-1499
Country	:	US
Telephone Number	:	816-347-2030
Fax Number	:	816-347-1979

Provider Business Practice Location Address
First Line	:	600 NW PRYOR RD UNIT 300
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-1104
Country	:	US
Telephone Number	:	816-524-1133
Fax Number	:	816-347-1979

Authorized Official
Title or Position	:	VICE PRESIDENT HEALTH SERVICES
Name	:	ANTHONY COLUMBATTO
Credential	:
Telephone Number	:	816-347-2030

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/26/2024

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Directions to “JOHN KNOX VILLAGE ” Practice Location

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