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General NPI Number Information
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NPI Number | 1588237523
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Entity Type | Organization
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Legal Business Name | CARDIO-KIDNEY VASCULAR CARE LLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 3161 N WEBB RD STE 220
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-402-0440
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Fax | 316-402-0451
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Provider Business Mailing Address
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Address Line | 3161 N WEBB RD STE 220
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-402-0440
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Fax | 316-402-0451
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANDREA SMITH
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Credential | LRT
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Telephone | 316-402-0441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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