Provider Demographics
NPI:1396839593
Name:KANSAS CITY PODIATRY ASSOCIATES, PA
Entity Type:Organization
Organization Name:KANSAS CITY PODIATRY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-894-4040
Mailing Address - Street 1:10600 QUIVIRA ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2314
Mailing Address - Country:US
Mailing Address - Phone:913-894-4040
Mailing Address - Fax:913-438-4725
Practice Address - Street 1:10600 QUIVIRA ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2314
Practice Address - Country:US
Practice Address - Phone:913-894-4040
Practice Address - Fax:913-438-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22030012OtherBCBS KANSAS CITY
MO364806307Medicaid
KS490218OtherBCBS KANSAS
KS490218OtherBCBS KANSAS
KS130159Medicare ID - Type Unspecified
0459170001Medicare NSC
MO364806307Medicaid
MOA440000BMedicare ID - Type Unspecified