Basic Information
| Provider Information | |||||||||
| NPI: | 1578002713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHLAND ORTHOPEDICS & SPORTS MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2790 CLAY EDWARDS DR STE 1230 | ||||||||
| Address2: | |||||||||
| City: | N KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168413805 | ||||||||
| FaxNumber: | 8162149330 | ||||||||
| Practice Location | |||||||||
| Address1: | 5844 NW BARRY RD | ||||||||
| Address2: | STE 320 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641541465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168413805 | ||||||||
| FaxNumber: | 8162149330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8168413805 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.