Basic Information
| Provider Information | |||||||||
| NPI: | 1588665020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESOURCE CENTER FOR GYNECOLOGIC ONCOLOGY L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 801606 | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641800001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6400 PROSPECT AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169260777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | VERDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8169260777 | ||||||||
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| 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 | 207VX0201X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 26042018 | 01 | MO | BCBS KC MO | OTHER | 100362880A | 05 | KS | MEDICAID | 505343707 | 05 | MO | MEDICAID | CH5536 | 01 | MO | RR MCR | OTHER |