Provider Demographics
NPI:1013175041
Name:DR CHARLES A KENDALL MD LLC
Entity Type:Organization
Organization Name:DR CHARLES A KENDALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-252-7800
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64013-0785
Mailing Address - Country:US
Mailing Address - Phone:816-228-8768
Mailing Address - Fax:816-228-8768
Practice Address - Street 1:10010 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-2160
Practice Address - Country:US
Practice Address - Phone:816-252-7800
Practice Address - Fax:816-228-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2119282N00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO40065013OtherBCBS OF KANSAS CITY
MOMA1061Medicare PIN
MO40065013OtherBCBS OF KANSAS CITY