Provider Demographics
NPI:1164778049
Name:VENA AND WOUND CARE CENTERS OF AMERICA, PA
Entity Type:Organization
Organization Name:VENA AND WOUND CARE CENTERS OF AMERICA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BROCKENBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-813-8308
Mailing Address - Street 1:3210 MERSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-2143
Mailing Address - Country:US
Mailing Address - Phone:816-813-8308
Mailing Address - Fax:816-924-3223
Practice Address - Street 1:21 N 12TH ST STE 103A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:816-531-0110
Practice Address - Fax:816-531-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432320208G00000X
MO2009015153208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3416Medicare PIN
MOMA4235Medicare PIN