Organization
MISSOURI PHLEBOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA JONES (CREDENTIALING)
(630) 725-2737
Entity
Organization
Contact information
Practice address
9501 N OAK TW, SUITE 201, NORTH OAK MEDICAL BUILDING IV, KANSAS CITY, MO 64155-3137
(816) 436-7373
(816) 436-7385
Mailing address
2015 SPRING RD STE 300, OAK BROOK, IL 60523-3944
(630) 725-2700
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
MO
2085R0204X
Vascular & Interventional Radiology Physician
—
MO
208600000X
Surgery Physician
—
MO
2086S0129X
Vascular Surgery Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37220011
BLUE CROSS BLUE SHIELD OF KANSAS CITY
MO
01
—
DF3698
MEDICARE RAILROAD
MO
Enumeration date
05/26/2006
Last updated
02/21/2022
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