Provider Demographics
NPI:1417243940
Name:SUSAN L DASTA DO PC
Entity Type:Organization
Organization Name:SUSAN L DASTA DO PC
Other - Org Name:DOWNTOWN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DASTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-332-6767
Mailing Address - Street 1:304 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1216
Mailing Address - Country:US
Mailing Address - Phone:816-332-6767
Mailing Address - Fax:816-332-6750
Practice Address - Street 1:304 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1216
Practice Address - Country:US
Practice Address - Phone:816-332-6767
Practice Address - Fax:816-332-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019232261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care