Provider Demographics
NPI:1801950589
Name:BROOKSIDE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BROOKSIDE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-523-4600
Mailing Address - Street 1:7337 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1357
Mailing Address - Country:US
Mailing Address - Phone:816-523-4600
Mailing Address - Fax:816-523-4724
Practice Address - Street 1:7337 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1357
Practice Address - Country:US
Practice Address - Phone:816-523-4600
Practice Address - Fax:816-523-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004675111NR0400X
MO2006023685225100000X
MOR5D432083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4598983OtherAETNA GROUP NUMBER
MO09455022OtherDR MILLER BCBS#
1093892119OtherM. KELLY MILLER, DC NPI#
1619088879OtherRAMON NICHOLS, MD NPI#
MO12455029OtherDR NICHOLS BCBS#
MO12973019OtherGROUP BCBS NUMBER
MO756879607Medicaid
MOT37446Medicare UPIN
P57428Medicare UPIN
Q49084Medicare UPIN
MO266645Medicare Oscar/Certification
MO0005046Medicare ID - Type UnspecifiedMICHAEL KELLY MILLER, DC
MO350011659Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO756879607Medicaid
MOL736769Medicare ID - Type UnspecifiedRAMON NICHOLS, MD
MO5905260001Medicare NSC
MO09455022OtherDR MILLER BCBS#
MOL730000Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER