Healthcare Provider Details

I. General information

NPI: 1265572481
Provider Name (Legal Business Name): CHANDRASEKHAR R VASAMREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY SUITE 320
JOPLIN MO
64804
US

IV. Provider business mailing address

100 MERCY WAY SUITE 320
JOPLIN MO
64804
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-5387
  • Fax: 417-781-7174
Mailing address:
  • Phone: 417-781-5387
  • Fax: 417-781-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24539
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMO-2009008971
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberKSDEA-FV1379646
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-33682
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2009008971
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number04-33682
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: