Provider Demographics
NPI:1134874167
Name:KANSAS CITY LIFESAVERS
Entity type:Organization
Organization Name:KANSAS CITY LIFESAVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:LJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-289-8977
Mailing Address - Street 1:302 US HIGHWAY 50 W
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1970
Mailing Address - Country:US
Mailing Address - Phone:636-283-8977
Mailing Address - Fax:
Practice Address - Street 1:302 US HIGHWAY 50 W
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1970
Practice Address - Country:US
Practice Address - Phone:636-283-8977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory