Provider Demographics
NPI:1720361108
Name:WILLIAM BROOKS, DO, PC
Entity Type:Organization
Organization Name:WILLIAM BROOKS, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-746-0128
Mailing Address - Street 1:9204 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1616
Mailing Address - Country:US
Mailing Address - Phone:816-746-0128
Mailing Address - Fax:816-505-2031
Practice Address - Street 1:9204 NW 80TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-1616
Practice Address - Country:US
Practice Address - Phone:816-746-0128
Practice Address - Fax:816-505-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111911261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C46866Medicare UPIN