Provider Demographics
NPI:1073543070
Name:PLAZA INFECTIOUS DISEASE, PC
Entity Type:Organization
Organization Name:PLAZA INFECTIOUS DISEASE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FREEBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-531-1550
Mailing Address - Street 1:4320 WORNALL RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5941
Mailing Address - Country:US
Mailing Address - Phone:816-531-1550
Mailing Address - Fax:816-531-8277
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 440
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-531-1550
Practice Address - Fax:816-531-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14271019OtherBC/BS
MO502598907Medicaid
KS100214320AMedicaid
MO5780000Medicare ID - Type Unspecified