Provider Demographics
NPI:1326019035
Name:MASSEY, VICKIE L (MD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:12200 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4045
Practice Address - Country:US
Practice Address - Phone:913-574-2650
Practice Address - Fax:913-574-2769
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1P322085R0001X
KS04-262972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125440TMedicaid
MO1326019035Medicaid
KS100125440LMedicaid
KS100125440MMedicaid
KS068002439Medicare PIN
MO1326019035Medicaid
KSK40000055Medicare PIN
KS100125440TMedicaid
KSP00953216Medicare PIN