Provider Demographics
NPI:1871708172
Name:SPINE & EXTREMITY REHABILITATION CENTER OF KANSAS CITY NORTH, INC.
Entity type:Organization
Organization Name:SPINE & EXTREMITY REHABILITATION CENTER OF KANSAS CITY NORTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:816-505-3422
Mailing Address - Street 1:8409 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2426
Mailing Address - Country:US
Mailing Address - Phone:816-420-0286
Mailing Address - Fax:816-420-8207
Practice Address - Street 1:8409 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2426
Practice Address - Country:US
Practice Address - Phone:816-420-0286
Practice Address - Fax:816-420-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL100000Medicare ID - Type UnspecifiedKCN MEDICARE