Provider Demographics
NPI:1467526665
Name:MEIEROTTO, RUBY E (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:E
Last Name:MEIEROTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUBY
Other - Middle Name:ELLEN
Other - Last Name:OBALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080134572085R0202X
KS04313352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOW19000167Medicare PIN
KS105032Medicare ID - Type Unspecified
I43346Medicare UPIN
KS105032OtherBLUE CROSS BLUE SHIELD
KS200347400AMedicaid