1275611444 NPI number — VEIN CLINIC OF GREATER KANSAS CITY, P.A.

Table of content: (NPI 1275611444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275611444 NPI number — VEIN CLINIC OF GREATER KANSAS CITY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEIN CLINIC OF GREATER KANSAS CITY, P.A.
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:
Provider Other Organization Name Type Code:
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:
1275611444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 W 109TH ST STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-541-3377
Provider Business Mailing Address Fax Number:
913-541-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 W 109TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-541-3377
Provider Business Practice Location Address Fax Number:
913-541-8082
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROORDA
Authorized Official First Name:
DAPHENE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MNAGER
Authorized Official Telephone Number:
913-541-3377

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0418701 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 0418958 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471S1302X , with the licence number: 72262 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471V0105X , with the licence number: 72262 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09280021 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 844398 . This is a "AENTA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65228 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KS0418701 . This is a "STATE LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 434308 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09509075 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 45750 . This is a "STATE LICENSE ARNP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 766289 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08561018 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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