Provider Demographics
NPI:1538486816
Name:CENTERPOINT MEDICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:CENTERPOINT MEDICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-508-4039
Mailing Address - Street 1:725 NW STATE ROUTE 7
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2426
Mailing Address - Country:US
Mailing Address - Phone:816-224-8999
Mailing Address - Fax:816-224-3121
Practice Address - Street 1:725 NW STATE ROUTE 7
Practice Address - Street 2:SUITE C
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2426
Practice Address - Country:US
Practice Address - Phone:816-224-8999
Practice Address - Fax:816-224-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200690010BMedicaid
MO1538486816Medicaid