Healthcare Provider Details

I. General information

NPI: 1134882681
Provider Name (Legal Business Name): INTERVENTIONAL NEPHROLOGY OF KANSAS CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E CAMBRIDGE CIRCLE DR STE 150
KANSAS CITY KS
66103-1393
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 410
NORTH KANSAS CITY MO
64116-3274
US

V. Phone/Fax

Practice location:
  • Phone: 913-233-0454
  • Fax: 913-233-0649
Mailing address:
  • Phone: 816-474-0458
  • Fax: 816-471-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW STINGO
Title or Position: PHYSICIAN
Credential: MD
Phone: 913-233-0454