Provider Demographics
NPI:1154792505
Name:KANSAS CITY GERIATRICS
Entity type:Organization
Organization Name:KANSAS CITY GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FARRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-931-5594
Mailing Address - Street 1:3014 OAK ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3240
Mailing Address - Country:US
Mailing Address - Phone:816-931-5594
Mailing Address - Fax:
Practice Address - Street 1:3014 OAK ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3240
Practice Address - Country:US
Practice Address - Phone:816-931-5594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008021948207Q00000X
MO113250207RG0300X, 311ZA0620X
MODO 113250314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0007343Medicare UPIN