Basic Information
| Provider Information | |||||||||
| NPI: | 1881648368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS CITY BONE & JOINT CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10701 NALL AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133815225 | ||||||||
| FaxNumber: | 9139010186 | ||||||||
| Practice Location | |||||||||
| Address1: | 10701 NALL AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133815225 | ||||||||
| FaxNumber: | 9139010186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | STEPHENSON | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9133815225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 363AS0400X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 2082S0105X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 207XS0106X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00616015 | 01 | BCBS KC | OTHER | 00616015 | 01 | BCBS OTHER | OTHER |