Provider Demographics
NPI:1619923968
Name:LEE'S SUMMIT FAMILY CARE LLC
Entity Type:Organization
Organization Name:LEE'S SUMMIT FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-524-2626
Mailing Address - Street 1:600 NW MURRAY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1204
Mailing Address - Country:US
Mailing Address - Phone:816-524-2626
Mailing Address - Fax:
Practice Address - Street 1:600 NW MURRAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1204
Practice Address - Country:US
Practice Address - Phone:816-524-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS09659028OtherBCBS OF KANSAS
MON880000Medicare ID - Type Unspecified