Provider Demographics
NPI:1023253176
Name:JAMES E GRACHECK, D O P C
Entity type:Organization
Organization Name:JAMES E GRACHECK, D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRACHECK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-444-0025
Mailing Address - Street 1:8607 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1210
Mailing Address - Country:US
Mailing Address - Phone:816-358-1231
Mailing Address - Fax:816-743-0484
Practice Address - Street 1:106 W 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5702
Practice Address - Country:US
Practice Address - Phone:816-444-0025
Practice Address - Fax:816-444-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240879205Medicaid
MO240879205Medicaid
0001636Medicare PIN