Provider Demographics
NPI:1881022366
Name:MISSION OF HOPE CLINIC
Entity Type:Organization
Organization Name:MISSION OF HOPE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLABORATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUJATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-522-5395
Mailing Address - Street 1:10500 E 350 HWY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1811
Mailing Address - Country:US
Mailing Address - Phone:816-876-3309
Mailing Address - Fax:816-778-1105
Practice Address - Street 1:6303 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4929
Practice Address - Country:US
Practice Address - Phone:816-356-4325
Practice Address - Fax:816-778-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service