Provider Demographics
NPI:1922097013
Name:GOPPERT - TRINITY FAMILY CARE, LLC
Entity Type:Organization
Organization Name:GOPPERT - TRINITY FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-508-4039
Mailing Address - Street 1:6675 HOLMES ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1215
Mailing Address - Country:US
Mailing Address - Phone:816-276-7650
Mailing Address - Fax:816-276-7090
Practice Address - Street 1:6675 HOLMES ROAD
Practice Address - Street 2:SUITE 360
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1215
Practice Address - Country:US
Practice Address - Phone:816-276-7600
Practice Address - Fax:816-276-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503959504Medicaid
MO503959504Medicaid