Basic Information
| Provider Information | |||||||||
| NPI: | 1992778526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS CITY GENERAL AND VASCULAR SURGEONS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10730 NALL AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137542800 | ||||||||
| FaxNumber: | 9137542899 | ||||||||
| Practice Location | |||||||||
| Address1: | 10730 NALL AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137542800 | ||||||||
| FaxNumber: | 9137542899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 08/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | CATES | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9137542800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04681017 | 01 | MO | BLUE CROSS BLUE SHIELD KC | OTHER |