MEDICARE: JACKSON COUNTY GASTROENTEROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1386699718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON COUNTY GASTROENTEROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 412622
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-2622
Country	:	US
Telephone Number	:	816-229-1191
Fax Number	:	816-229-1198

Provider Business Practice Location Address
First Line	:	206 NW MOCK AVE
Second Line	:	SUITE 100
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-229-1191
Fax Number	:	816-229-1198

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY M VARDAKIS
Credential	:	DO
Telephone Number	:	816-229-1191

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/31/2009

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