# VEIN CLINIC OF GREATER KANSAS CITY, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275611444
- **Authorized official:** MS. DAPHENE R ROORDA (OFFICE MNAGER)
- **Authorized official phone:** (913) 541-3377

## Contact information

- **Practice address:** 4400 W 109TH ST STE 150, OVERLAND PARK, KS 66211-1319
- **Practice address phone:** (913) 541-3377
- **Practice address fax:** (913) 541-8082
- **Mailing address:** 4400 W 109TH ST STE 150, OVERLAND PARK, KS 66211-1319
- **Mailing address phone:** (913) 541-3377
- **Mailing address fax:** (913) 541-8082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0418701 | KS | — |
| 208600000X | Surgery Physician | 0418958 | KS | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 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

- **Enumeration date:** 11/02/2006
- **Last updated:** 12/10/2020

## 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 |