Excelsior Springs Physicians Clinic

Primary specialty

Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X

License

R6J43 Issued in MO

Legal business name

EXCELSIOR SPRINGS PHYSICIANS CLINIC

Practice address

1700 Rainbow Blvd
Excelsior Springs, MO 64024-1182

Phone

(816) 629-2623

Fax

(816) 629-2722

NPI assigned

Feb 4, 2014

Last updated

Feb 4, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer L Boomgarden, CRMA, BSHSA, EMBA

Title

Physicians Practice Manager

Phone

(816) 629-2623

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Excelsior Springs Physicians Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Excelsior Springs Physicians Clinics LLC

  • Internal Medicine Physician
  • Excelsior Springs, MO
  • NPI 1710300298
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391472000000",
    "number": "1629491105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N JESSE JAMES RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "640241202",
            "telephone_number": "816-630-6722",
            "fax_number": "816-630-2471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 RAINBOW BLVD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "640241182",
            "telephone_number": "816-629-2623",
            "fax_number": "816-629-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR SPRINGS PHYSICIANS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-04",
        "last_updated": "2014-02-04",
        "status": "A",
        "authorized_official_last_name": "BOOMGARDEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIANS PRACTICE MANAGER",
        "authorized_official_telephone_number": "816-629-2623",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRMA, BSHSA, EMBA"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "MO",
            "license": "R6J43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID#",
            "identifier": "MA 4388",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Excelsior Springs Family Dentistry LLC
• Excelsior Springs Hospital (Freedom Health Care)
• Excelsior Springs Nursing and Rehab LLC (Excelsior Springs Nursing & Rehab)
• Excelsior Springs Pediatric Clinic
• Excelsior Springs Physician Clinic LLC
• Excelsior Springs Physicians Clinics LLC
• Excelsior Springs Public Schools 40
• Amanda Jane Findley, PMHNP-BC
• Jake Findley, DDS
• First Resort Chiropractic

• Adolescent Medicine (Family Medicine) Physician in Excelsior Springs, MO
• Providers in Excelsior Springs, MO by specialty
• Adolescent Medicine (Family Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.