| Carondelet Physician Services Inc | |
|
1900 S Broadway Oak Grove MO 64075-9020 | |
| (816) 690-6566 | |
| (816) 625-8276 |
| Full Name | Carondelet Physician Services Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1900 S Broadway, Oak Grove, Missouri |
| Authorized Official Name and Position | Steven R Cleary (VP/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 1900 S Broadway Oak Grove MO 64075-9020 Ph: (816) 690-6566 |
| NPI Number | 1811293582 |
|---|---|
| Provider Enumeration Date | 01/28/2011 |
| Last Update Date | 05/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811293582 | NPI | - | NPPES |
| 501269500 | Medicaid | MO | |
| 39532013 | Other | BCBS OF KANSAS CITY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34421 (Missouri) | Primary |