Provider Demographics
NPI:1306893003
Name:RAYMORE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:RAYMORE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-318-1725
Mailing Address - Street 1:1118 REMINGTON PLZ
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8588
Mailing Address - Country:US
Mailing Address - Phone:816-318-1725
Mailing Address - Fax:816-318-1189
Practice Address - Street 1:1118 REMINGTON PLZ
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8584
Practice Address - Country:US
Practice Address - Phone:816-318-1725
Practice Address - Fax:816-318-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS34978011OtherBCBS OF KANSAS - RAYMORE
DD2407Medicare PIN
MOS280000Medicare PIN