MEDICARE: CLINICAL CARDIOVASCULAR ASSOCIATES PA

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	207RC0000X	Cardiovascular Disease Physician		MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831198027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL CARDIOVASCULAR ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 8650
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-0650
Country	:	US
Telephone Number	:	913-381-7117
Fax Number	:	913-383-1316

Provider Business Practice Location Address
First Line	:	206 NW MOCK AVE
Second Line	:	SUITE 200
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-224-3107
Fax Number	:	816-224-3914

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KERRY HOOK
Credential	:
Telephone Number	:	913-381-7117

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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