Provider Demographics
NPI:1326002551
Name:NORTHLAND FAMILY CARE, P.C.
Entity Type:Organization
Organization Name:NORTHLAND FAMILY CARE, P.C.
Other - Org Name:SEAPORT FAMILY PRACTICE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-4740
Mailing Address - Street 1:9151 NE 81ST TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1176
Mailing Address - Country:US
Mailing Address - Phone:816-781-4740
Mailing Address - Fax:816-781-0971
Practice Address - Street 1:9151 NE 81ST TER STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1176
Practice Address - Country:US
Practice Address - Phone:816-781-4740
Practice Address - Fax:816-781-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18129013OtherBCBS GROUP NUMBER
MO18129013OtherBCBS GROUP NUMBER