Healthcare Provider Details

I. General information

NPI: 1114152998
Provider Name (Legal Business Name): GRANT R. VAN SCOYOC CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 COLLEGE BLVD
LEAWOOD KS
66211-1910
US

IV. Provider business mailing address

8717 W 110TH ST STE 600
OVERLAND PARK KS
66210-2126
US

V. Phone/Fax

Practice location:
  • Phone: 913-338-4100
  • Fax: 913-428-2951
Mailing address:
  • Phone: 913-428-2900
  • Fax: 913-428-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number556890
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-89164-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: