Basic Information
| Provider Information | |||||||||
| NPI: | 1245270404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORSA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 504807 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631504807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341496 | ||||||||
| FaxNumber: | 9132341116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 WASHINGTON ST | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641115961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169306035 | ||||||||
| FaxNumber: | 9132341116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 2002012290 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 2002012290 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 205829005 | 05 | MO | MEDICAID | 100422770A | 05 | KS | MEDICAID | 30790014 | 01 | MO | BCBS | OTHER | 300130623 | 01 | MO | RAILROAD MEDICARE | OTHER |