Basic Information
| Provider Information | |||||||||
| NPI: | 1063593796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 WORNALL RD | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169311883 | ||||||||
| FaxNumber: | 8167563645 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 ARKANSAS ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858413636 | ||||||||
| FaxNumber: | 8167563645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 08/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | SAMMS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8169311883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00264010 | 01 | MO | MO BCBS/KC GRP # | OTHER | 016778 | 01 | KS | KS BCBS GROUP # | OTHER |