Basic Information
| Provider Information | |||||||||
| NPI: | 1770552093 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THORACIC AND VASCULAR SURGEONS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 PROSPECT AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165237088 | ||||||||
| FaxNumber: | 8165235747 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 PROSPECT AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165237088 | ||||||||
| FaxNumber: | 8165235747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8165237088 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.