Basic Information
| Provider Information | |||||||||
| NPI: | 1124677299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COOPERATING PLAN MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 NW JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640157242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162241740 | ||||||||
| FaxNumber: | 8162241364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 NW JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640157242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162241740 | ||||||||
| FaxNumber: | 8162241364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | ABRAM | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8163651866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.