Provider Demographics
NPI:1255439998
Name:CLIFFVIEW MEDICAL GROUP PC
Entity type:Organization
Organization Name:CLIFFVIEW MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ALMA
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-350-9100
Mailing Address - Street 1:PO BOX 9370
Mailing Address - Street 2:DEPT 209 4429 S RIVER BLVD SUITE C
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-0170
Mailing Address - Country:US
Mailing Address - Phone:816-350-9100
Mailing Address - Fax:816-350-9104
Practice Address - Street 1:4429 S RIVER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-350-9100
Practice Address - Fax:816-350-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR2119207R00000X
MOMD33977207R00000X
MOMDR7PZ1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID
1520000AMedicare ID - Type Unspecified