Provider Demographics
NPI:1265650717
Name:DR. ROY C. DAVIS, P.C.
Entity Type:Organization
Organization Name:DR. ROY C. DAVIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-7688
Mailing Address - Street 1:3601 NW 75TH CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4258
Mailing Address - Country:US
Mailing Address - Phone:816-741-1914
Mailing Address - Fax:
Practice Address - Street 1:8080 WARD PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2034
Practice Address - Country:US
Practice Address - Phone:816-444-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09686025OtherBCBS
MO060265OtherVALUE OPTIONS
MO060265OtherVALUE OPTIONS
MO0005098AMedicare ID - Type Unspecified