1700887056 NPI number — CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC

Table of content: (NPI 1700887056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700887056 NPI number — CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CANCER REHABILITATION SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700887056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8900 STATE LINE RD
Provider Second Line Business Mailing Address:
STE 333
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66206-1941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-491-9404
Provider Business Mailing Address Fax Number:
913-754-0365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 STATE LINE RD
Provider Second Line Business Practice Location Address:
STE 333
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66206-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-491-9404
Provider Business Practice Location Address Fax Number:
913-754-0365
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
913-491-9404

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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