MEDICARE: MISSOURI PHLEBOLOGY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	202K00000X	Phlebology Physician	MO
2	2085R0204X	Vascular & Interventional Radiology Physician	MO
3	208600000X	Surgery Physician	MO
4	2086S0129X	Vascular Surgery Physician	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF3698	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	37220011	OTHER	MO	BLUE CROSS BLUE SHIELD OF KANSAS CITY

General Provider Information

NPI Number	:	1932155389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI PHLEBOLOGY INC

Provider Business Mailing Address
First Line	:	2015 SPRING RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-3944
Country	:	US
Telephone Number	:	630-725-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 N OAK TW, SUITE 201
Second Line	:	NORTH OAK MEDICAL BUILDING IV
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3137
Country	:	US
Telephone Number	:	816-436-7373
Fax Number	:	816-436-7385

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CYNTHIA JONES
Credential	:
Telephone Number	:	630-725-2737

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/21/2022

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Directions to “MISSOURI PHLEBOLOGY INC ” Practice Location

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