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General NPI Number Information
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NPI Number | 1780797142
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Entity Type | Organization
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Legal Business Name | COLON AND RECTAL SURGEONS OF KC PA
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 8901 W 74TH ST SUITE 149
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2204
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Country | US
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Telephone | 913-677-4010
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Fax | 913-677-1164
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Provider Business Mailing Address
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Address Line | 8901 W 74TH ST SUITE 149
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2204
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Country | US
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Telephone | 913-677-4010
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Fax | 913-677-1164
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ELIZABETH VIVONA
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Credential |
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Telephone | 913-677-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | R7G39
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License Number State | MO
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