Provider Demographics
NPI:1649467937
Name:HEALTH CENTERS OF AMERICA-KANSAS CITY, LLC
Entity type:Organization
Organization Name:HEALTH CENTERS OF AMERICA-KANSAS CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:RYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-763-9165
Mailing Address - Street 1:5308 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-2731
Mailing Address - Country:US
Mailing Address - Phone:816-763-9165
Mailing Address - Fax:816-763-9208
Practice Address - Street 1:5308 E 115TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2731
Practice Address - Country:US
Practice Address - Phone:816-763-9165
Practice Address - Fax:816-763-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13367208000000X
MOR3788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50215Medicare UPIN