Provider Demographics
NPI:1043334105
Name:KANSAS CITY GASTROENTEROLOGY & HEPATOLOGY
Entity Type:Organization
Organization Name:KANSAS CITY GASTROENTEROLOGY & HEPATOLOGY
Other - Org Name:BRADLEY L FREILICH MD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:816-361-0055
Mailing Address - Street 1:6675 HOLMES RD STE 430
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1167
Mailing Address - Country:US
Mailing Address - Phone:816-361-0055
Mailing Address - Fax:816-361-5775
Practice Address - Street 1:6675 HOLMES RD STE 430
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1167
Practice Address - Country:US
Practice Address - Phone:816-361-0055
Practice Address - Fax:816-361-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL148662Medicare ID - Type Unspecified
MOS67952Medicare UPIN