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General NPI Number Information
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NPI Number | 1013062090
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Entity Type | Organization
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Legal Business Name | IVNA MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 4811 S ARROWHEAD DR
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6981
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Country | US
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Telephone | 816-356-4600
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Fax | 816-353-7296
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Provider Business Mailing Address
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Address Line | 4811 S ARROWHEAD DR
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6981
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Country | US
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Telephone | 816-356-4600
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Fax | 816-353-7296
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Authorized Official
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Title or Position | MEMBER
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Name | VIKRANTH ANNEBOINA
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Credential |
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Telephone | 816-356-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2016039188
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License Number State | MO
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