Provider Demographics
NPI:1578002713
Name:NORTHLAND ORTHOPEDICS & SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:NORTHLAND ORTHOPEDICS & SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-841-3805
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 1230
Mailing Address - Street 2:
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3253
Mailing Address - Country:US
Mailing Address - Phone:816-841-3805
Mailing Address - Fax:816-214-9330
Practice Address - Street 1:5844 NW BARRY RD
Practice Address - Street 2:STE 320
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1465
Practice Address - Country:US
Practice Address - Phone:816-841-3805
Practice Address - Fax:816-214-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA6490Medicare PIN