Provider Demographics
NPI:1346511268
Name:OA CENTERS OF KANSAS CITY, LLC
Entity Type:Organization
Organization Name:OA CENTERS OF KANSAS CITY, LLC
Other - Org Name:FREEDOM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:402-934-8255
Mailing Address - Street 1:4200 LITTLE BLUE PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8312
Mailing Address - Country:US
Mailing Address - Phone:816-867-4140
Mailing Address - Fax:636-412-7989
Practice Address - Street 1:4200 LITTLE BLUE PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8312
Practice Address - Country:US
Practice Address - Phone:816-867-4140
Practice Address - Fax:636-412-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025640208100000X
MO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty