Excelsior Springs Physicians Clinics LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D0113134 Issued in MO

Legal business name

EXCELSIOR SPRINGS PHYSICIANS CLINICS LLC

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 Clinic

  • Adolescent Medicine (Family Medicine) Physician
  • Excelsior Springs, MO
  • NPI 1629491105
  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": "1710300298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 W 6TH ST",
            "city": "LAWSON",
            "state": "MO",
            "postal_code": "640628973",
            "telephone_number": "816-580-0055",
            "fax_number": "816-580-0064"
        },
        {
            "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 CLINICS LLC",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "D0113134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "MA4388",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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 Clinic
• Excelsior Springs Public Schools 40
• Amanda Jane Findley, PMHNP-BC
• Jake Findley, DDS
• First Resort Chiropractic
• Kimberly Renee Fortuna, PT

• Internal Medicine Physician in Excelsior Springs, MO
• Providers in Excelsior Springs, MO by specialty
• Internal 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.