Basic Information
| Provider Information | |||||||||
| NPI: | 1164476339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST AORTIC & VASCULAR INSTITUTE, P.C. | ||||||||
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| OtherOrganizationName: | KANSAS CITY VASCULAR, P.C. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 CLAY EDWARDS DRIVE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168425555 | ||||||||
| FaxNumber: | 8166599123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 CLAY EDWARDS DRIVE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168425555 | ||||||||
| FaxNumber: | 8166599123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | SMALL | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8168721601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.