MEDICARE: SOCRATES C. JAMOULIS MD

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	2085R0202X	Diagnostic Radiology Physician	143388	MO
2	2085R0202X	Diagnostic Radiology Physician	23369	KS

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	2267634	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	26323071	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1912980194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOCRATES C. JAMOULIS MD

Provider Business Mailing Address
First Line	:	PO BOX 414975
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-4975
Country	:	US
Telephone Number	:	816-455-0661
Fax Number	:	816-454-1080

Provider Business Practice Location Address
First Line	:	9501 N OAK TRFY
Second Line	:	#100
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2256
Country	:	US
Telephone Number	:	816-455-0661
Fax Number	:	816-454-1080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/28/2010

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Directions to “ SOCRATES C. JAMOULIS MD” Practice Location

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