Kennedy, Russell L.

Kennedy, Russell L. is an individual health care provider with primary practice located at 6151 N Main Street Rd , Webb City MO 64870-8189. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kennedy, Russell L. can be contacted via phone (417) 781-0408.

Contact Information

Primary practice address
6151 N Main Street Rd Webb City MO 64870-8189
Phone: (417) 781-0408
Fax: (417) 556-5377
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2001014928 Missouri

Profile Details

NPI number 1316985989
LBN Legal business name Kennedy, Russell L.
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 3rd, 2006
Last updated Mar 13th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316985989 NPPES
Missouri Other P00800220 RAIL ROAD MEDICARE
Missouri MEDICAID 200307600C RAIL ROAD MEDICARE
Missouri MEDICAID 200049470A RAIL ROAD MEDICARE
Missouri MEDICAID 1316985989 RAIL ROAD MEDICARE

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