Provider Demographics
NPI:1487697447
Name:MORAN, NANCY C (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 S CLIFF AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7016
Mailing Address - Country:US
Mailing Address - Phone:816-503-3700
Mailing Address - Fax:816-503-3723
Practice Address - Street 1:4721 S CLIFF AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7016
Practice Address - Country:US
Practice Address - Phone:816-503-3700
Practice Address - Fax:816-503-3723
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001640102OtherCHP PROVIDER NUMBER PHFUC
22039026OtherBCBS PHF URGENT CARE
4528879OtherAETNA
080181189OtherRR MEDICARE
481159444OtherJAYHAWK TAX ID
10001640101OtherCHP PROVIDER NUMBER FCI
20916093OtherBCBS
18960020OtherCFU BCBS
22039026OtherBCBS PHF URGENT CARE
MOP00746234Medicare PIN
20916093OtherBCBS
F79472Medicare UPIN