Provider Demographics
NPI:1386627388
Name:QUINTERO, VICTOR J (RN ARNP CRNA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:J
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:RN ARNP CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 N 139TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4234
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:4510 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3238
Practice Address - Country:US
Practice Address - Phone:816-364-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1492371111163W00000X
MO111099163W00000X, 367500000X
KS55144363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5717188OtherCOMMUNITY HEALTH PLAN
KS20003630BMedicaid
KSP00396938OtherRAILROAD MEDICARE
KS15577OtherPREFERRED HEALTH SYSTEMS
MO21047031OtherBLUE CROSS BLUE SHIELD KC
KS145355OtherBLUE CROSS BLUE SHIELD KS
MO917831216Medicaid
MOP00365475OtherRAILROAD MEDICARE
MOW495420AMedicare PIN
KS145355Medicare PIN
MO5717188OtherCOMMUNITY HEALTH PLAN
KS15577OtherPREFERRED HEALTH SYSTEMS
KS145355OtherBLUE CROSS BLUE SHIELD KS
MOP00365475OtherRAILROAD MEDICARE