Provider Demographics
NPI:1780846865
Name:KANSAS CITY CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:KANSAS CITY CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-523-4525
Mailing Address - Street 1:6420 PROSPECT AVE STE T509
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4139
Mailing Address - Country:US
Mailing Address - Phone:816-523-4525
Mailing Address - Fax:816-523-6307
Practice Address - Street 1:101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3505
Practice Address - Country:US
Practice Address - Phone:816-523-4525
Practice Address - Fax:816-523-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS110587207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4540000AMedicare PIN