Provider Demographics
NPI:1295024149
Name:I-70 MEDICAL CLINIC - ALMA
Entity Type:Organization
Organization Name:I-70 MEDICAL CLINIC - ALMA
Other - Org Name:I70 COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:660-674-2403
Mailing Address - Fax:
Practice Address - Street 1:206 S COUNTY RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MO
Practice Address - Zip Code:64001
Practice Address - Country:US
Practice Address - Phone:660-674-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center