Provider Demographics
NPI:1609118702
Name:JOHN KNOX VILLAGE
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGE
Other - Org Name:JKV PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - HEALTH & RESIDENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-2030
Mailing Address - Street 1:PO BOX 25010
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5010
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:600 NW PRYOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1104
Practice Address - Country:US
Practice Address - Phone:913-642-4900
Practice Address - Fax:913-381-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011034116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODT2931OtherRR
KS200674690BMedicaid
MOMA4183Medicare PIN