Basic Information
| Provider Information | |||||||||
| NPI: | 1497095756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORPORATE CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 SWIFT AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162210058 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2025 SWIFT AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162210058 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 02/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8162210058 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 2003009415 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.