Basic Information
| Provider Information | |||||||||
| NPI: | 1316675317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS CITY CARE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 E MEYER BLVD STE 208 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167535144 | ||||||||
| FaxNumber: | 8557370585 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MEYER BLVD STE 208 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167535144 | ||||||||
| FaxNumber: | 8557370585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARRETO | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | ALBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8167772766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KANSAS CITY CARE CLINIC | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.