Provider Demographics
NPI:1609121912
Name:RAVINDER GOSWAMI LLC
Entity Type:Organization
Organization Name:RAVINDER GOSWAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-569-0563
Mailing Address - Street 1:5311 NW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4381
Mailing Address - Country:US
Mailing Address - Phone:816-569-0563
Mailing Address - Fax:
Practice Address - Street 1:1080 NW SOUTH OUTER RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3087
Practice Address - Country:US
Practice Address - Phone:816-228-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024411103T00000X, 310400000X, 314000000X
KS0435222310400000X, 3104A0625X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility