Basic Information
| Provider Information | |||||||||
| NPI: | 1801067236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEIGHBORHOOD FAMILY CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 INDEPENDENCE AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641242927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162416334 | ||||||||
| FaxNumber: | 8162415830 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 INDEPENDENCE AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641242927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162416334 | ||||||||
| FaxNumber: | 8162415830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOSLYN | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
| AuthorizedOfficialMiddleName: | WELSH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8162416334 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | C16398 | 01 | PTAN | OTHER |