St Joseph Specialty Clinic PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

112862 Issued in MO

Legal business name

ST JOSEPH SPECIALTY CLINIC PC

Doing business as

St Joseph Specialty Clinic PC

Practice address

2600 Miller St
Bethany, MO 64424-2701

Phone

(660) 425-0253

NPI assigned

Jul 23, 2006

Organization subpart

No

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

Authorized official

Name

Kenneth W Shewell, MDNPI 1700854023

Title

Secretary

Phone

(816) 866-5105

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St Joseph Specialty Clinic PC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth W Shewell, MD

  • Surgery Physician
  • Bethany, MO
  • NPI 1700854023
  Authorized official Same address or phone

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1962424895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8657",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645088657",
            "telephone_number": "816-866-5105",
            "fax_number": "816-207-0454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242701",
            "telephone_number": "660-425-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH SPECIALTY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "SHEWELL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "816-866-5105",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "MO",
            "license": "112862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208865105",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Joseph Specialty Clinic PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rolling Hills Creative Living, Inc
• Kenneth W Shewell, MD
• Emily Kaylene Shuck
• Patricia Slaughter, LMSW
• Solutions for Families, Inc.
• Scott Dale Staatz, O.D.
• Coy Stephens, DPT
• Madison Nicole Stephens, DPT
• Kimberly D Strain, CPT
• Kathy Sweat, RPH

• Surgery Physician in Bethany, MO
• Providers in Bethany, MO by specialty
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.