Basic Information
| Provider Information | |||||||||
| NPI: | 1871835876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDGECOCK | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | PACKARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 DIAMOND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641164321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165613003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1950 DIAMOND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641164321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165613003 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2013 | ||||||||
| LastUpdateDate: | 01/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 04-42361 | KS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 60366 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2019024768 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.