Provider Demographics
NPI:1619426863
Name:MOUNT EVEREST MEDICAL
Entity Type:Organization
Organization Name:MOUNT EVEREST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-716-3059
Mailing Address - Street 1:4010 WASHINGTON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2609
Mailing Address - Country:US
Mailing Address - Phone:816-895-3799
Mailing Address - Fax:816-817-6338
Practice Address - Street 1:4010 WASHINGTON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2609
Practice Address - Country:US
Practice Address - Phone:816-895-3799
Practice Address - Fax:816-817-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X
VAR6D61208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty