Provider Demographics
NPI:1861641680
Name:CARL L FALCONE MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Entity Type:Organization
Organization Name:CARL L FALCONE MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PROVIDENCE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12365
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0365
Mailing Address - Country:US
Mailing Address - Phone:913-825-6512
Mailing Address - Fax:913-328-7011
Practice Address - Street 1:2300 HUTTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4436
Practice Address - Country:US
Practice Address - Phone:913-721-3387
Practice Address - Fax:913-721-3375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-17
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432718207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty