Provider Demographics
NPI:1669770434
Name:SPORTS MED PLUS OF LEES SUMMIT, LLC
Entity type:Organization
Organization Name:SPORTS MED PLUS OF LEES SUMMIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-554-2600
Mailing Address - Street 1:2741 NE MCBAIN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-7880
Mailing Address - Country:US
Mailing Address - Phone:816-554-2600
Mailing Address - Fax:816-554-2603
Practice Address - Street 1:2741 NE MCBAIN DR
Practice Address - Street 2:SUITE B
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-7880
Practice Address - Country:US
Practice Address - Phone:816-554-2600
Practice Address - Fax:816-554-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty