Provider Demographics
NPI:1922040799
Name:KANSAS CITY CLINICAL NEUROLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:KANSAS CITY CLINICAL NEUROLOGY ASSOCIATES, LTD.
Other - Org Name:KCCNA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-524-1700
Mailing Address - Street 1:276 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-524-1700
Mailing Address - Fax:816-524-1794
Practice Address - Street 1:276 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-524-1700
Practice Address - Fax:816-524-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0700000Medicare ID - Type Unspecified