MEDICARE: HEART AND VASCULAR CARE, P. C.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356598577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART AND VASCULAR CARE, P. C.

Provider Business Mailing Address
First Line	:	2817 MCCLELLAND BLVD
Second Line	:	SUITE 220
City	:	JOPLIN
State	:	MO
Zip	:	64804-1629
Country	:	US
Telephone Number	:	417-782-2190
Fax Number	:	417-782-6750

Provider Business Practice Location Address
First Line	:	805 GULF ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1238
Country	:	US
Telephone Number	:	417-782-2190
Fax Number	:	417-782-6750

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH MARK GRAHAM
Credential	:	M. D.
Telephone Number	:	417-782-2190

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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