Provider Demographics
NPI:1831137462
Name:DERMATOLOGY SPECIALISTS OF KANSAS CITY, P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF KANSAS CITY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHANIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-942-1150
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-942-1150
Mailing Address - Fax:816-942-0322
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 125
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-942-1150
Practice Address - Fax:816-942-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00815010OtherBC/BC GRP PROVIDER #
MO00815010OtherBC/BC GRP PROVIDER #