Provider Demographics
NPI:1770608135
Name:KCMOSD
Entity type:Organization
Organization Name:KCMOSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:KCMO
Authorized Official - Middle Name:
Authorized Official - Last Name:SD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-418-8653
Mailing Address - Street 1:1215 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-3152
Mailing Address - Country:US
Mailing Address - Phone:816-418-8653
Mailing Address - Fax:
Practice Address - Street 1:3221 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2062
Practice Address - Country:US
Practice Address - Phone:816-418-2075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare