Provider Demographics
NPI:1316591035
Name:JOHN KNOX VILLAGE
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHRM
Authorized Official - Phone:816-347-2109
Mailing Address - Street 1:400 NW MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1498
Mailing Address - Country:US
Mailing Address - Phone:816-347-2109
Mailing Address - Fax:
Practice Address - Street 1:400 NW MURRAY RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1498
Practice Address - Country:US
Practice Address - Phone:816-347-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN KNOX VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801488404Medicaid