Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2024-08-01
- Last updated
- 2024-08-01
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 9995 SE HIGHWAY J
- City
- COLLINS MO
- Postal code
- 647386151
- Phone
- 816-309-3599
Organization contact
- Name
- STEPHANIE BOULDIN
- Title
- Managing Member
- Phone
- 8163053599
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.