Provider Demographics
NPI:1255432951
Name:METRO EMERGENCY PHYSICIAN LLC
Entity type:Organization
Organization Name:METRO EMERGENCY PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-932-2047
Mailing Address - Street 1:PO BOX 78009
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-8009
Mailing Address - Country:US
Mailing Address - Phone:866-898-7142
Mailing Address - Fax:616-957-9824
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
141161401OtherWC
KS100329590BMedicaid
141161400OtherWC
141161403OtherWC
KS100329590DMedicaid
MO25572016OtherBCBS
141161402OtherWC
MO502186703Medicaid
KS100329590AMedicaid
C16203Medicare PIN
141161401OtherWC