Provider Demographics
NPI:1457303604
Name:TODD A STASTNY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:TODD A STASTNY MEDICAL ASSOCIATES
Other - Org Name:FAMILY MEDICINE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STASTNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-228-1500
Mailing Address - Street 1:1700 NW MOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3118
Mailing Address - Country:US
Mailing Address - Phone:816-228-1500
Mailing Address - Fax:816-228-3805
Practice Address - Street 1:1700 NW MOCK AVE
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3118
Practice Address - Country:US
Practice Address - Phone:816-228-1500
Practice Address - Fax:816-228-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2J77207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCB6556OtherMEDICARE RAILROAD
MOK840000Medicare PIN