Provider Demographics
NPI:1134208150
Name:KANSAS CITY PULMONOLOGY PRACTICE, LLC
Entity type:Organization
Organization Name:KANSAS CITY PULMONOLOGY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-1919
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:T-303
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1180
Mailing Address - Country:US
Mailing Address - Phone:816-333-1919
Mailing Address - Fax:
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:T-303
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1180
Practice Address - Country:US
Practice Address - Phone:816-333-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501218507Medicaid
KS200422770AMedicaid
MOW780000Medicare PIN
MO501218507Medicaid