| Summit Skin Care Incorporated | |
|
3521 Ne Ralph Powell Rd Ste C Lees Summit MO 64064-2324 | |
| (816) 554-8346 | |
| (816) 554-9470 |
| Full Name | Summit Skin Care Incorporated |
|---|---|
| Speciality | Family Medicine |
| Location | 3521 Ne Ralph Powell Rd Ste C, Lees Summit, Missouri |
| Authorized Official Name and Position | Bruce E Fearon (OWNER / PRESIDENT) |
| Authorized Official Contact | 8165547546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Skin Care Incorporated 3521 Ne Ralph Powell Rd Ste C Lees Summit MO 64064-2324 Ph: (816) 554-8346 | Summit Skin Care Incorporated 3521 Ne Ralph Powell Rd Ste C Lees Summit MO 64064-2324 Ph: (816) 554-8346 |
| NPI Number | 1902099500 |
|---|---|
| Provider Enumeration Date | 08/27/2007 |
| Last Update Date | 09/16/2022 |
| Medicare PECOS PAC ID | 2264459650 |
|---|---|
| Medicare Enrollment ID | O20051025000663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902099500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 102868 (Missouri) | Primary |
| Provider Name | Bruce Edward Fearon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689666059 PECOS PAC ID: 4082513304 Enrollment ID: I20051026000321 |
| Provider Name | Makenzie K Stroup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063132827 PECOS PAC ID: 2769852110 Enrollment ID: I20230125001408 |
| Provider Name | Joseph M Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922086693 PECOS PAC ID: 6901858141 Enrollment ID: I20230608002427 |
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