Provider Demographics
NPI:1669670964
Name:KANSAS CITY SKIN AND CANCER CENTER, LLC
Entity Type:Organization
Organization Name:KANSAS CITY SKIN AND CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-281-3827
Mailing Address - Street 1:5810 NW BARRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1493
Mailing Address - Country:US
Mailing Address - Phone:816-584-8100
Mailing Address - Fax:816-584-8106
Practice Address - Street 1:5810 NW BARRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1493
Practice Address - Country:US
Practice Address - Phone:816-584-8100
Practice Address - Fax:816-584-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002466207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39381019OtherBLUE CROSS
P00439269OtherRAILROAD MEDICARE
DG5134OtherRAILROAD MEDICARE
P00439269OtherRAILROAD MEDICARE
H60344Medicare UPIN