Provider Demographics
NPI:1750858221
Name:SIGNATURE MEDICAL GROUP OF KC, PA
Entity Type:Organization
Organization Name:SIGNATURE MEDICAL GROUP OF KC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-849-0311
Mailing Address - Street 1:12639 OLD TESSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:20920 W 151ST ST STE 100
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7243
Practice Address - Country:US
Practice Address - Phone:913-381-5225
Practice Address - Fax:913-901-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies