Provider Demographics
NPI:1417090275
Name:KANSAS CITY CANCER CENTER
Entity Type:Organization
Organization Name:KANSAS CITY CANCER CENTER
Other - Org Name:KANSAS CITY CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-541-4600
Mailing Address - Street 1:9200 INDIAN CREEK PKWY
Mailing Address - Street 2:BUILDING 9 SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2002
Mailing Address - Country:US
Mailing Address - Phone:913-541-4600
Mailing Address - Fax:913-577-5851
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:913-234-0475
Practice Address - Fax:913-234-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-097633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1717644OtherNCPDP