Basic Information
| Provider Information | |||||||||
| NPI: | 1891757183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR RHEUMATIC DISEASE & THE CENTER FOR ALLERGY-IMMUNOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 WORNALL ROAD | ||||||||
| Address2: | MED PLAZA II, 4TH FLOOR SUITE 40 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165310930 | ||||||||
| FaxNumber: | 8167532671 | ||||||||
| Practice Location | |||||||||
| Address1: | 4330 WORNALL RD | ||||||||
| Address2: | MED PLAZA II, 4TH FLOOR | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165310930 | ||||||||
| FaxNumber: | 8167532671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 05/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | WARNER | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8165310930 | ||||||||
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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 | 207KA0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207KI0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Clinical & Laboratory Immunology | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 32612 | 01 | KS | BCBS | OTHER | 100212740A | 05 | KS | MEDICAID | 501717409 | 05 | MO | MEDICAID | 15867014 | 01 | MO | BCBS | OTHER |