Provider Demographics
NPI:1396833067
Name:LANDMARK MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LANDMARK MEDICAL CENTER, INC.
Other - Org Name:LANDMARK MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-464-2333
Mailing Address - Street 1:8800 NW 112TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1104
Mailing Address - Country:US
Mailing Address - Phone:816-464-2333
Mailing Address - Fax:816-464-2015
Practice Address - Street 1:8800 NW 112TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1104
Practice Address - Country:US
Practice Address - Phone:816-464-2333
Practice Address - Fax:816-464-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6890000Medicare ID - Type UnspecifiedFACILITY PROVIDER NUBER