Provider Demographics
NPI:1629702741
Name:KC SPECIALTIES OCCUPATIONAL HEALTH
Entity Type:Organization
Organization Name:KC SPECIALTIES OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-795-6000
Mailing Address - Street 1:4741 S ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6957
Mailing Address - Country:US
Mailing Address - Phone:816-795-6000
Mailing Address - Fax:
Practice Address - Street 1:4741 S ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6957
Practice Address - Country:US
Practice Address - Phone:816-795-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780957290OtherOCCUPATIONAL MEDICINE WORKERS COMPENSATION