EXCELSIOR SPRINGS PHYSICIANS CLINIC – NPI #1629491105
Family Medicine

A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.

EXCELSIOR SPRINGS PHYSICIANS CLINIC is a provider located in EXCELSIOR SPRINGS, MO. NPPES has assigned the NPI number 1629491105 to EXCELSIOR SPRINGS PHYSICIANS CLINIC on February 04, 2014. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207QA0000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine, specializing in Adolescent Medicine

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EXCELSIOR SPRINGS PHYSICIANS CLINIC below.

NPI Profile for
EXCELSIOR SPRINGS PHYSICIANS CLINIC

NPI Number
1629491105
Enumeration Date

(more than 12 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EXCELSIOR SPRINGS PHYSICIANS CLINIC
Primary location
1700 RAINBOW BLVD
EXCELSIOR SPRINGS, MO 64024-1182
Phone: (816) 629-2623 Fax: (816) 629-2722
Mailing address
1010 N JESSE JAMES RD
EXCELSIOR SPRINGS, MO 64024-1202
Phone: (816) 630-6722 Fax: (816) 630-2471
Organization Subpart
No
Authorized Official
JENNIFER BOOMGARDEN
PHYSICIANS PRACTICE MANAGER
Phone: (816) 629-2623
Updated
Identifiers

Identifiers for EXCELSIOR SPRINGS PHYSICIANS CLINIC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERMEDICARE ID#MOMA 4388
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207QA0000X
- Family Medicine / Adolescent Medicine (Primary)
MO R6J43

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.