Organization
COLON AND RECTAL SURGEONS OF KC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH VIVONA (PRACTICE MANAGER)
(913) 677-4010
Entity
Organization
Contact information
Practice address
8901 W 74TH ST, SUITE 149, SHAWNEE MISSION, KS 66204-2204
(913) 677-4010
(913) 677-1164
Mailing address
8901 W 74TH ST, SUITE 149, SHAWNEE MISSION, KS 66204-2204
(913) 677-4010
(913) 677-1164
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
R7G39
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R7G39
MISSOURI STATE MED LICENS
MO
Enumeration date
08/17/2006
Last updated
08/05/2014
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