Provider Demographics
NPI:1326080755
Name:NORTHEAST KANSAS GI CONSULTANTS PA
Entity Type:Organization
Organization Name:NORTHEAST KANSAS GI CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:RAO G
Authorized Official - Last Name:VASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-220-5193
Mailing Address - Street 1:3601 S 4TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5015
Mailing Address - Country:US
Mailing Address - Phone:913-220-5193
Mailing Address - Fax:913-814-9989
Practice Address - Street 1:3601 S 4TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5015
Practice Address - Country:US
Practice Address - Phone:913-220-5193
Practice Address - Fax:913-814-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27796207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111081Medicare ID - Type UnspecifiedGROUP NUMBER