| State Line Medical Group Llc | |
|
7611 State Line Rd Suite 103 Kansas City MO 64114-6801 | |
| (816) 333-9886 | |
| Not Available |
| Full Name | State Line Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7611 State Line Rd, Kansas City, Missouri |
| Authorized Official Name and Position | Ken Washington (VP) |
| Authorized Official Contact | 8163339886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Line Medical Group Llc 7611 State Line Rd Suite 103 Kansas City MO 64114-6801 Ph: (816) 333-9886 | State Line Medical Group Llc 7611 State Line Rd Suite 103 Kansas City MO 64114-6801 Ph: (816) 333-9886 |
| NPI Number | 1679529853 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679529853 | NPI | - | NPPES |
| 29398029 | Other | MO | BCBS OF KC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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