Provider Demographics
NPI:1972749638
Name:CENTERPOINT HOSPITAL BASED PHYSICIANS, LLC
Entity type:Organization
Organization Name:CENTERPOINT HOSPITAL BASED PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-698-7001
Mailing Address - Street 1:19600 E 39TH ST S
Mailing Address - Street 2:3RD FLOOR OB
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2301
Mailing Address - Country:US
Mailing Address - Phone:816-698-7189
Mailing Address - Fax:816-698-7369
Practice Address - Street 1:19600 E 39TH ST S
Practice Address - Street 2:3RD FLOOR OB
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2301
Practice Address - Country:US
Practice Address - Phone:816-698-7189
Practice Address - Fax:816-698-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200627590 AMedicaid
KS200627590 AMedicaid
MODP2374Medicare PIN