Provider Demographics
NPI:1598747545
Name:PECULIAR MEDICAL CLINIC
Entity Type:Organization
Organization Name:PECULIAR MEDICAL CLINIC
Other - Org Name:CASS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-358-8888
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0788
Mailing Address - Country:US
Mailing Address - Phone:816-779-1100
Mailing Address - Fax:816-779-1119
Practice Address - Street 1:300 S MAIN
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9729
Practice Address - Country:US
Practice Address - Phone:816-779-1100
Practice Address - Fax:816-779-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
32899015OtherBCBS GRP
7060000Medicare PIN