| Carondelet Physician Services, Inc. | |
|
1454 Sw Eagles Pkwy Grain Valley MO 64029-8508 | |
| (816) 847-2390 | |
| (816) 847-2392 |
| Full Name | Carondelet Physician Services, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1454 Sw Eagles Pkwy, Grain Valley, Missouri |
| Authorized Official Name and Position | Steven R Cleary (VP AND CFO) |
| Authorized Official Contact | 8169432819 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carondelet Physician Services, Inc. 801 Nw Saint Mary Dr Suite 230 Blue Springs MO 64014-2524 Ph: (816) 655-5792 | Carondelet Physician Services, Inc. 1454 Sw Eagles Pkwy Grain Valley MO 64029-8508 Ph: (816) 847-2390 |
| NPI Number | 1699040006 |
|---|---|
| Provider Enumeration Date | 03/19/2012 |
| Last Update Date | 03/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699040006 | NPI | - | NPPES |
| 39532013 | Other | BLUE CROSS BLUE SHIELD OF KANSAS CITY | |
| 501269500 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 106682 (Missouri) | Primary |
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