Provider Demographics
NPI:1881693679
Name:CARDIOVASCULAR SURGERY, INC.
Entity type:Organization
Organization Name:CARDIOVASCULAR SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:LATTA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:816-942-0770
Mailing Address - Street 1:930 CARONDELET DR
Mailing Address - Street 2:STE 104
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4855
Mailing Address - Country:US
Mailing Address - Phone:816-942-0770
Mailing Address - Fax:816-942-0668
Practice Address - Street 1:930 CARONDELET DR
Practice Address - Street 2:STE 104
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4855
Practice Address - Country:US
Practice Address - Phone:816-942-0770
Practice Address - Fax:816-942-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4110000Medicare ID - Type Unspecified