| Belton Family Practice Clinic Llc | |
|
204 E North Ave Belton MO 64012-2013 | |
| (816) 331-7744 | |
| Not Available |
| Full Name | Belton Family Practice Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 204 E North Ave, Belton, Missouri |
| Authorized Official Name and Position | Mickey S Pickler (VICE PRESIDENT) |
| Authorized Official Contact | 8165084039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Belton Family Practice Clinic Llc 204 E North Ave Belton MO 64012-2013 Ph: (816) 331-7744 | Belton Family Practice Clinic Llc 204 E North Ave Belton MO 64012-2013 Ph: (816) 331-7744 |
| NPI Number | 1477500221 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 10/17/2017 |
| Medicare PECOS PAC ID | 5193717601 |
|---|---|
| Medicare Enrollment ID | O20040402000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477500221 | NPI | - | NPPES |
| 100452550A | Medicaid | KS | |
| 506091404 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ossama Al-assafeen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912078452 PECOS PAC ID: 9638117906 Enrollment ID: I20050419000423 |
| Provider Name | Kent A Bogner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295720340 PECOS PAC ID: 5799725743 Enrollment ID: I20050509000969 |
| Provider Name | Cassandra L Brewster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801826193 PECOS PAC ID: 3072528413 Enrollment ID: I20060207000444 |
| Provider Name | David R Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275528895 PECOS PAC ID: 0042348898 Enrollment ID: I20100514000591 |
| Provider Name | Kirk D Ridley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922093954 PECOS PAC ID: 1557499324 Enrollment ID: I20100514000788 |
| Provider Name | Logan F Kratt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467461558 PECOS PAC ID: 4587856778 Enrollment ID: I20101006000633 |
| Provider Name | Zandra R Gottman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235529512 PECOS PAC ID: 4789903493 Enrollment ID: I20150430002429 |
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