MEDICARE: H ANDREW PICKETT MD PC

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	207Q00000X	Family Medicine Physician	R6C90	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD2297	OTHER	MO	MEDICARE RR

General Provider Information

NPI Number	:	1770778375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H ANDREW PICKETT MD PC

Provider Business Mailing Address
First Line	:	1236 N JESSE JAMES RD
Second Line	:
City	:	EXCELSIOR SPRG
State	:	MO
Zip	:	64024-1119
Country	:	US
Telephone Number	:	816-637-8900
Fax Number	:	816-637-4011

Provider Business Practice Location Address
First Line	:	1236 N JESSE JAMES RD
Second Line	:
City	:	EXCELSIOR SPRGS
State	:	MO
Zip	:	64024-1119
Country	:	US
Telephone Number	:	816-637-8900
Fax Number	:	816-637-4011

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. H. ANDREW PICKETT
Credential	:	M.D.
Telephone Number	:	816-637-8900

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	12/28/2007

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