Provider Demographics
NPI:1295968865
Name:KANSAS CITY VASCULAR & GENERAL SURGERY GROUP LLC
Entity type:Organization
Organization Name:KANSAS CITY VASCULAR & GENERAL SURGERY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-508-4090
Mailing Address - Street 1:10730 NALL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1366
Mailing Address - Country:US
Mailing Address - Phone:913-754-2800
Mailing Address - Fax:913-754-2899
Practice Address - Street 1:10730 NALL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1366
Practice Address - Country:US
Practice Address - Phone:913-754-2800
Practice Address - Fax:913-754-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200689610AMedicaid
MO1295968865Medicaid
MO1295968865Medicaid
MOMA2363Medicare PIN