Provider Demographics
NPI:1710172234
Name:DOCTORS CLINIC OF KC
Entity Type:Organization
Organization Name:DOCTORS CLINIC OF KC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-444-6055
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-0480
Mailing Address - Country:US
Mailing Address - Phone:816-444-6055
Mailing Address - Fax:816-444-6033
Practice Address - Street 1:6650 TROOST AVE
Practice Address - Street 2:STE 205
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1215
Practice Address - Country:US
Practice Address - Phone:816-444-6055
Practice Address - Fax:816-444-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9J37207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP291524OtherMEDICARE PROVIDER NUMBER
MOC21805Medicare UPIN