Provider Demographics
NPI:1235381120
Name:CAH ACQUISITION COMPANY #6 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY #6 LLC
Other - Org Name:I-70 MEDICAL CLINIC-CONCORDIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:660-335-7408
Mailing Address - Street 1:1100 MAIN ST
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2120
Mailing Address - Country:US
Mailing Address - Phone:660-463-1010
Mailing Address - Fax:660-463-1070
Practice Address - Street 1:607 S MAIN
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-0000
Practice Address - Country:US
Practice Address - Phone:660-463-1010
Practice Address - Fax:660-463-1070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I-70 MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT920000Medicare Oscar/Certification