Provider Demographics
NPI:1629001326
Name:POWERS FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:POWERS FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-229-3265
Mailing Address - Street 1:206 NW MOCK
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014
Mailing Address - Country:US
Mailing Address - Phone:816-229-3265
Mailing Address - Fax:816-229-3149
Practice Address - Street 1:206 NW MOCK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2507
Practice Address - Country:US
Practice Address - Phone:816-229-3265
Practice Address - Fax:816-229-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR780000Medicare ID - Type UnspecifiedGROUP NUMBER