Provider Demographics
NPI:1649235037
Name:INFECTIOUS DISEASE ASSOCIATES OF KANSAS CITY PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF KANSAS CITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:BS MBA
Authorized Official - Phone:816-822-8486
Mailing Address - Street 1:2340 E MEYER BLVD BLDG 2
Mailing Address - Street 2:SUITE 392
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1105
Mailing Address - Country:US
Mailing Address - Phone:816-822-8486
Mailing Address - Fax:816-822-0490
Practice Address - Street 1:2340 E MEYER BLVD BLDG 2
Practice Address - Street 2:SUITE 392
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1105
Practice Address - Country:US
Practice Address - Phone:816-822-8486
Practice Address - Fax:816-822-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100114760AMedicaid
MO502397706Medicaid
MO502397706Medicaid
MO2780000AMedicare Oscar/Certification
KS2780000EMedicare Oscar/Certification