Provider Demographics
NPI:1700887056
Name:CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC
Entity Type:Organization
Organization Name:CANCER REHABILITATION SPECIALISTS LYMPHATIC AND VENOUS DISORDERS INC
Other - Org Name:CANCER REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-491-9404
Mailing Address - Street 1:8900 STATE LINE RD
Mailing Address - Street 2:STE 333
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1941
Mailing Address - Country:US
Mailing Address - Phone:913-491-9404
Mailing Address - Fax:913-754-0365
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:STE 333
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1941
Practice Address - Country:US
Practice Address - Phone:913-491-9404
Practice Address - Fax:913-754-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSL340000Medicare ID - Type Unspecified
KS4603970001Medicare NSC