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2002 S 51st St Kansas City KS 66106-2419 | |
| (913) 722-3100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2002 S 51st St, Kansas City, Kansas |
| Authorized Official Name and Position | Lisa Harvey (ACTING CEO) |
| Authorized Official Contact | 9137223100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
340 Southwest Blvd Kansas City KS 66103-2150 Ph: (913) 722-3100 | 2002 S 51st St Kansas City KS 66106-2419 Ph: (913) 722-3100 |
| NPI Number | 1457978645 |
|---|---|
| Provider Enumeration Date | 07/03/2020 |
| Last Update Date | 04/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457978645 | NPI | - | NPPES |
| 200621130B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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