NPIMap

Organization Active NPI

J Anthony Woltjen, MD, PC

  • Specialist
  • Blue Springs, MO
National Provider Identifier
1720355159
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
R4B13 Issued in MO
Legal business name
J ANTHONY WOLTJEN, MD, PC
Practice address
100 NW Mock Ave
Suite 101
Blue Springs, MO 64014-2501
Phone
(816) 220-9080
Fax
(816) 220-9010
NPI assigned
Nov 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
John Anthony Woltjen, M.D.
Title
Physician
Phone
(816) 220-9080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X R4B13 MO Primary

Addresses

Primary practice location

100 NW Mock Ave
Suite 101
Blue Springs, MO 64014-2501

Mailing address

100 NW Mock Ave
Suite 101
Blue Springs, MO 64014-2501
Phone (816) 220-9080

Other identifiers 1

IdentifierTypeStateIssuer
0008617OtherPTAN

National Provider Directory

National Provider Directory

Locations

100 NW Mock Ave
Ste 101
Blue Springs, MO 64014
Phone (816) 220-9080

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1720355159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NW MOCK AVE",
            "address_2": "SUITE 101",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142501",
            "telephone_number": "816-220-9080",
            "fax_number": "816-220-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NW MOCK AVE",
            "address_2": "SUITE 101",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142501",
            "telephone_number": "816-220-9080",
            "fax_number": "816-220-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J ANTHONY WOLTJEN, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "WOLTJEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "816-220-9080",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "R4B13",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "0008617",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Springs, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; 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.