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Organization
VEIN CLINIC OF GREATER KANSAS CITY, P.A.
Active
Organization
VEIN CLINIC OF GREATER KANSAS CITY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAPHENE R ROORDA (OFFICE MNAGER)
(913) 541-3377
Entity
Organization
Contact information
Practice address
4400 W 109TH ST STE 150, OVERLAND PARK, KS 66211-1319
(913) 541-3377
(913) 541-8082
Mailing address
4400 W 109TH ST STE 150, OVERLAND PARK, KS 66211-1319
(913) 541-3377
(913) 541-8082
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0418701
KS
208600000X
Surgery Physician
0418958
KS
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
2471S1302X
Sonography Radiologic Technologist
72262
NULL
2471S1302X
Sonography Radiologic Technologist
72262
—
2471V0105X
Vascular Sonography Radiologic Technologist
72262
NULL
2471V0105X
Vascular Sonography Radiologic Technologist
72262
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08561018
BLUE CROSS BLUE SHIELD GR
MO
01
—
09280021
BLUE CROSS BLUE SHIELD
MO
01
—
09509075
BCBS
KS
01
—
434308
AETNA PPO
—
01
—
45750
STATE LICENSE ARNP
KS
01
—
65228
BLUE CROSS BLUE SHIELD
KS
01
—
766289
HUMANA
—
01
—
844398
AENTA HMO
—
01
—
KS0418701
STATE LICENSE
KS
Enumeration date
11/02/2006
Last updated
12/10/2020
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