Healthcare Provider Details

I. General information

NPI: 1912954777
Provider Name (Legal Business Name): KANSAS CITY HEART GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CARONDELET DR SUITE 200
KANSAS CITY MO
64114-4855
US

IV. Provider business mailing address

PO BOX 872788
KANSAS CITY MO
64187-0001
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-7727
  • Fax: 816-941-7456
Mailing address:
  • Phone: 913-362-9690
  • Fax: 913-384-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: COLLEEN STACK
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-941-7727