Individual ProviderCharles R KellyPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address4400 Broadway St, Ste 540, Kansas City, MO 64111-3498(816) 931-3013PECOS EnrollmentBased on the most recent information from CMS, provider Charles R Kelly does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1356333496Provider TypeIndividualFull NameKelly, Charles RCredentialMDGenderMaleEnumeration Date8/16/2005Last Updated7/8/2007Contact InformationPractice LocationPractice Address4400 Broadway St, Ste 540, Kansas City, MO 64111-3498Phone(816) 931-3013FaxUnlisted FaxMailing LocationMailing Address4400 Broadway St, Ste 540, Kansas City, MO 64111-3498PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicenseMDR4208MissouriCode208100000XDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense0413279Kansas