Provider Demographics
NPI:1073887014
Name:KC PODIATRY CARE, PA
Entity Type:Organization
Organization Name:KC PODIATRY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-432-2000
Mailing Address - Street 1:7301 MISSION RD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3006
Mailing Address - Country:US
Mailing Address - Phone:913-432-2000
Mailing Address - Fax:913-432-2001
Practice Address - Street 1:7301 MISSION RD
Practice Address - Street 2:SUITE 152
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3006
Practice Address - Country:US
Practice Address - Phone:913-432-2000
Practice Address - Fax:913-432-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114130OtherMEDICARE PROVIDER GROUP # FOR KS (OUTSIDE KANSAS CITY LIMITS)
KS114130OtherMEDICARE PIN FOR KS #
KSKA2540OtherPTAN (FOR JOHNSON COUNTY AREA)
KS26580022OtherBCBS
KSKA2541OtherPTAN (FOR OUTSIDE OF KANSAS CITY/JOHNSON CO AREAS)
KSS340000OtherMEDICARE PROVIDER GROUP #
KSP00183110OtherMEDICARE RAILROAD
KSS340000OtherMEDICARE PROVIDER GROUP #
KSKA2541OtherPTAN (FOR OUTSIDE OF KANSAS CITY/JOHNSON CO AREAS)
KSS34A115Medicare PIN