MEDICARE: SPINE & EXTREMITY REHABILITATION CENTER OF KANSAS CITY NORTH, INC.

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	332BC3200X	Customized Equipment (DME)		MO

General Provider Information

NPI Number	:	1871708172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE & EXTREMITY REHABILITATION CENTER OF KANSAS CITY NORTH, INC.

Provider Business Mailing Address
First Line	:	8409 N MAIN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2426
Country	:	US
Telephone Number	:	816-420-0286
Fax Number	:	816-420-8207

Provider Business Practice Location Address
First Line	:	8409 N MAIN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2426
Country	:	US
Telephone Number	:	816-420-0286
Fax Number	:	816-420-8207

Authorized Official
Title or Position	:	MANAGER, OWNER, PHYSICAL THERAPIST
Name	:	ROBERT A MITCHELL
Credential	:	PT
Telephone Number	:	816-505-3422

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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