| Kenneth Dolen Jackson, MD | |
| 
					930 Carondelet Dr, Suite 104, Kansas City, MO 64114-4855  | |
| (816) 941-2222 | |
| (816) 941-2282 | 
| Full Name | Kenneth Dolen Jackson | 
|---|---|
| Gender | Male | 
| Speciality | Surgery | 
| Location | 930 Carondelet Dr, Kansas City, Missouri | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1295898179 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Y00000X | Otolaryngology | 9406666 (Kansas) | Secondary | 
| 208600000X | Surgery | 2008033152 (Missouri) | Primary | 
| Entity Name | Prime Healthcare Kansas City - Physician Services Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1427449487 PECOS PAC ID: 7315267325 Enrollment ID: O20150514001835  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kenneth Dolen Jackson, MD 930 Carondelet Dr 201, Kansas City, MO 64114-4698 Ph: (816) 941-2222  | Kenneth Dolen Jackson, MD 930 Carondelet Dr, Suite 104, Kansas City, MO 64114-4855 Ph: (816) 941-2222  | 
Steven L Glorsky, MD Surgery Medicare: Medicare Enrolled Practice Location: 2301 Holmes St, Kansas City, MO 64108 Phone: 816-404-1000  | |
Mrs. Samantha Machen Alsop, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 4330 Wornall Rd Ste 50, Kansas City, MO 64111 Phone: 816-931-3312 Fax: 816-531-9862  | |
Karthik Vamanan, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 4330 Wornall Rd Ste 50, Kansas City, MO 64111 Phone: 816-931-3312 Fax: 816-531-9862  | |
Dr. Ronald John Sharp, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 2401 Gillham Rd, Kansas City, MO 64108 Phone: 816-234-3574 Fax: 816-983-6885  | |
Ms. Rosa Elizabeth Turcios, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 2330 E Meyer Blvd, Ste T209, Kansas City, MO 64132 Phone: 816-235-3932 Fax: 877-285-6815  | |
Muzammil Aziz, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 4330 Wornall Rd Ste 50, Kansas City, MO 64111 Phone: 816-931-3312 Fax: 816-531-9862  | |
Arhana Chattopadhyay, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 2401 Gillham Rd, Kansas City, MO 64108 Phone: 816-701-5200  |