Provider Demographics
NPI:1720055668
Name:COATNEY CLINIC, INC
Entity Type:Organization
Organization Name:COATNEY CLINIC, INC
Other - Org Name:MYRAL COATNEY, D.O., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-231-5600
Mailing Address - Street 1:6235 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64126-2631
Mailing Address - Country:US
Mailing Address - Phone:913-248-9693
Mailing Address - Fax:913-248-9383
Practice Address - Street 1:6235 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64126-2631
Practice Address - Country:US
Practice Address - Phone:816-231-5600
Practice Address - Fax:816-231-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO09563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB020000Medicare ID - Type Unspecified