National Provider Identifier Database

EXCELSIOR SPRINGS PHYSICIANS CLINIC
Adolescent 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.


Contact Information

EXCELSIOR SPRINGS PHYSICIANS CLINIC
1700 RAINBOW BLVD
EXCELSIOR SPRINGS, MO64024-1182
Phone: 816-629-2623
Fax: 816-629-2722
Website:
Specialty Taxonomy Code
* Adolescent Medicine 207QA0000X

* Indicates primary specialty

NPI Profile & details for EXCELSIOR SPRINGS PHYSICIANS CLINIC

NPI Number 1629491105
Legal business name
LBN
EXCELSIOR SPRINGS PHYSICIANS CLINIC
Authorized official JENNIFER BOOMGARDEN - (PHYSICIANS PRACTICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 02/04/2014
Last updated 02/04/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • MO License #: R6J43
  • MO Other: MA 4388 MEDICARE ID#

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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