Provider Demographics
NPI:1194923607
Name:RHEUMATOLOGY SPECIALISTS OF KANSAS CITY PA
Entity type:Organization
Organization Name:RHEUMATOLOGY SPECIALISTS OF KANSAS CITY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-753-5736
Mailing Address - Street 1:450 E 4TH ST
Mailing Address - Street 2:#200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 E 4TH ST
Practice Address - Street 2:#200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-1170
Practice Address - Country:US
Practice Address - Phone:816-753-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502982002Medicaid
3208006OtherUNITED HEALTHCARE
MO502982002Medicaid
C50555Medicare UPIN