MEDICARE: ANGELA MORAN CST/CFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant		MO

General Provider Information

NPI Number	:	1063601151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MORAN CST/CFA

Provider Business Mailing Address
First Line	:	5624 N AMES AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2179
Country	:	US
Telephone Number	:	816-584-8246
Fax Number	:	888-329-6432

Provider Business Practice Location Address
First Line	:	5624 N AMES AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2179
Country	:	US
Telephone Number	:	816-584-8246
Fax Number	:	888-329-6432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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