Provider Demographics
NPI:1225054331
Name:PLAZA PRIMARY CARE AND GERIATRICS
Entity Type:Organization
Organization Name:PLAZA PRIMARY CARE AND GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-561-9200
Mailing Address - Street 1:4440 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3315
Mailing Address - Country:US
Mailing Address - Phone:816-561-9200
Mailing Address - Fax:816-561-5766
Practice Address - Street 1:4440 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3315
Practice Address - Country:US
Practice Address - Phone:816-561-9200
Practice Address - Fax:816-561-5766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAZA PRIMARY CARE AND GERIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP870000Medicare PIN