Provider Demographics
NPI:1295792224
Name:KANSAS CITY PULMONARY CLINIC PA
Entity type:Organization
Organization Name:KANSAS CITY PULMONARY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-1919
Mailing Address - Street 1:6420 PROSPECT AVENUE T303
Mailing Address - Street 2:KANSAS CITY PULMONARY CLINIC PA
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132
Mailing Address - Country:US
Mailing Address - Phone:816-333-1919
Mailing Address - Fax:816-361-1930
Practice Address - Street 1:6420 PROSPECT AVENUE T303
Practice Address - Street 2:KANSAS CITY PULMONARY CLINIC PA
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-333-1919
Practice Address - Fax:816-361-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10021231AMedicaid
KS10021231AMedicaid
MO4150000AMedicare ID - Type Unspecified