=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205902921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAL CARDIOVASCULAR ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19550 E 39TH ST S SUITE 227
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64057-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-795-9716
-----------------------------------------------------
Fax | 816-795-6358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8709
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64114-0709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-7117
-----------------------------------------------------
Fax | 913-383-1316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. JANE DOWDING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-381-7117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------