Provider Demographics
NPI:1447292180
Name:JOHN T BOPP PC
Entity type:Organization
Organization Name:JOHN T BOPP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-0606
Mailing Address - Street 1:6155 OAK ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2238
Mailing Address - Country:US
Mailing Address - Phone:816-333-0606
Mailing Address - Fax:816-523-5418
Practice Address - Street 1:6155 OAK ST
Practice Address - Street 2:SUITE E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2238
Practice Address - Country:US
Practice Address - Phone:816-333-0606
Practice Address - Fax:816-523-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS061006Medicare ID - Type UnspecifiedKANSAS
MOJ390000AMedicare ID - Type UnspecifiedMO RURAL
KSJ390000BMedicare ID - Type UnspecifiedJOHNSON WYANDOTTE
MOJ390000Medicare ID - Type UnspecifiedKANSAS CITY