=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477505402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOTHORACIC ANESTHESIA ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 02/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 WORNALL RD CARDIOTHORACIC ANESTHESIA ASSOCIATES DEPT
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-389-6030
-----------------------------------------------------
Fax | 816-389-6034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9233 WARD PKWY SUITE 230
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64114-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-389-6030
-----------------------------------------------------
Fax | 816-389-6034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MR. KENNETH DYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-389-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------