Provider Demographics
NPI:1952773533
Name:KANSAS CITY CENTER FOR HIP PRESERVATION AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:KANSAS CITY CENTER FOR HIP PRESERVATION AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-721-5140
Mailing Address - Street 1:5901 NW 63RD TER
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3319
Mailing Address - Country:US
Mailing Address - Phone:816-718-4010
Mailing Address - Fax:
Practice Address - Street 1:6100 TIMBERIDGE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-6099
Practice Address - Country:US
Practice Address - Phone:816-721-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024964207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1104870054OtherNPI
MO1104870054Medicaid
MO1104870054Medicaid