Provider Demographics
NPI:1508209735
Name:CARESPOT OF RAYTOWN (9490 EAST 350 HIGHWAY), LLC
Entity Type:Organization
Organization Name:CARESPOT OF RAYTOWN (9490 EAST 350 HIGHWAY), LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO & GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-600-4060
Mailing Address - Street 1:115 EAST PARK DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2311
Mailing Address - Country:US
Mailing Address - Phone:615-600-4075
Mailing Address - Fax:615-309-4624
Practice Address - Street 1:9490 E 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6509
Practice Address - Country:US
Practice Address - Phone:615-600-4060
Practice Address - Fax:615-309-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty