Provider Demographics
NPI:1275925182
Name:MISSOURI CARIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:MISSOURI CARIS HEALTHCARE LLC
Other - Org Name:CARIS HEALTHCARE, KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-4762
Mailing Address - Street 1:3980 SOUTH JACKSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3980 SOUTH JACKSON DRIVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-795-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIS HEALTHCARE LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
261659Medicare Oscar/Certification