Provider Demographics
NPI:1881648368
Name:KANSAS CITY BONE & JOINT CLINIC PA
Entity Type:Organization
Organization Name:KANSAS CITY BONE & JOINT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:913-381-5225
Mailing Address - Street 1:10701 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1231
Mailing Address - Country:US
Mailing Address - Phone:913-381-5225
Mailing Address - Fax:913-901-0186
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
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:2006-05-20
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00616015OtherBCBS KC
00616015OtherBCBS OTHER
00616015OtherBCBS KC
00616015OtherBCBS KC
KS1150000AMedicare PIN
00616015OtherBCBS OTHER
MOCP7317Medicare ID - Type UnspecifiedRR MEDICARE
KSCH8371Medicare ID - Type UnspecifiedRR MEDICARE
KSKA1580Medicare PIN