MEDICARE: JOHN A. GILLEN II MD ORTHOPAEDIC SPECIALISTS P.A.

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	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC5878	OTHER	MO	RR MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17519026	OTHER	MO	BCBSKC GROUP #

General Provider Information

NPI Number	:	1780879858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A. GILLEN II MD ORTHOPAEDIC SPECIALISTS P.A.

Provider Business Mailing Address
First Line	:	PO BOX 412043
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-2043
Country	:	US
Telephone Number	:	913-647-4102
Fax Number	:	913-647-4122

Provider Business Practice Location Address
First Line	:	900 MAIN ST
Second Line	:
City	:	GRANDVIEW
State	:	MO
Zip	:	64030-2477
Country	:	US
Telephone Number	:	816-331-6700
Fax Number	:	816-876-2399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN A GILLEN II
Credential	:	M.D.
Telephone Number	:	816-331-6700

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	10/12/2007

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