Basic Information
| Provider Information | |||||||||
| NPI: | 1558549949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLN MEDICAL SPECIALISTS, LLC | ||||||||
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| OtherOrganizationName: | SLN WOUND CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5830 NW BARRY RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641542778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165327706 | ||||||||
| FaxNumber: | 8165327163 | ||||||||
| Practice Location | |||||||||
| Address1: | 5830 NW BARRY RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641542778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165327706 | ||||||||
| FaxNumber: | 8165327163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 02/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOORMAN | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8165327763 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT LUKES NORTHLAND HOSPITAL CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.