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General NPI Number Information
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NPI Number | 1275611444
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Entity Type | Organization
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Legal Business Name | VEIN CLINIC OF GREATER KANSAS CITY, P.A.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 4400 W 109TH ST STE 150
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1319
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Country | US
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Telephone | 913-541-3377
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Fax | 913-541-8082
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Provider Business Mailing Address
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Address Line | 4400 W 109TH ST STE 150
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1319
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Country | US
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Telephone | 913-541-3377
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Fax | 913-541-8082
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Authorized Official
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Title or Position | OFFICE MNAGER
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Name | MS. DAPHENE R ROORDA
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Credential |
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Telephone | 913-541-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0418701
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0418958
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 72262
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 72262
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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