Basic Information
| Provider Information | |||||||||
| NPI: | 1487697447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORAN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4721 S CLIFF AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640557016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165033700 | ||||||||
| FaxNumber: | 8165033723 | ||||||||
| Practice Location | |||||||||
| Address1: | 4721 S CLIFF AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640557016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165033700 | ||||||||
| FaxNumber: | 8165033723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 103373 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10001640102 | 01 | CHP PROVIDER NUMBER PHFUC | OTHER | 22039026 | 01 | BCBS PHF URGENT CARE | OTHER | 4528879 | 01 | AETNA | OTHER | 080181189 | 01 | RR MEDICARE | OTHER | 481159444 | 01 | JAYHAWK TAX ID | OTHER | 10001640101 | 01 | CHP PROVIDER NUMBER FCI | OTHER | 20916093 | 01 | BCBS | OTHER | 18960020 | 01 | CFU BCBS | OTHER |