Healthcare Provider Details

I. General information

NPI: 1588745236
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E RUSSELL AVE BLDG C
WARRENSBURG MO
64093-1242
US

IV. Provider business mailing address

4330 WORNALL RD SUITE 2000
KANSAS CITY MO
64111-3217
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax: 816-756-3645
Mailing address:
  • Phone: 816-931-1883
  • Fax: 816-756-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SAMMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-931-1883