MEDICARE: KCMOSD

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1770608135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KCMOSD

Provider Business Mailing Address
First Line	:	1215 E TRUMAN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64106-3152
Country	:	US
Telephone Number	:	816-418-8653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 INDIANA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-2062
Country	:	US
Telephone Number	:	816-418-2075
Fax Number	:

Authorized Official
Title or Position	:	CLINIC
Name	:	KCMO SD
Credential	:
Telephone Number	:	816-418-8653

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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Directions to “KCMOSD ” Practice Location

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