Basic Information
| Provider Information | |||||||||
| NPI: | 1174987580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ARCHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 DIAMOND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641164329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165613003 | ||||||||
| FaxNumber: | 8168891584 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 DIAMOND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641164329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165613003 | ||||||||
| FaxNumber: | 8168891584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 62586 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 04-46572 | KS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2022032016 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.