Provider Demographics
NPI:1316137953
Name:MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC
Entity type:Organization
Organization Name:MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-451-0600
Mailing Address - Street 1:PO BOX 7127
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0127
Mailing Address - Country:US
Mailing Address - Phone:816-421-0601
Mailing Address - Fax:816-421-0604
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 260
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-421-0601
Practice Address - Fax:816-421-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0811343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty