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General NPI Number Information
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NPI Number | 1801208723
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Entity Type | Individual
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Provider Name | MATTHEW VLACH AA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 4401 WORNALL RD ANESTHESIA DEPT.
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City | KANSAS CITY
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State | MO
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Zip | 64111-3220
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Country | US
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Telephone | 816-932-2033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50447
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 816-932-7940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 2014016797
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License Number State | MO
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