Basic Information
| Provider Information | |||||||||
| NPI: | 1104220391 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KCVA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 E MEYER BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311114 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4801 E LINWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641282226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168614700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2014 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | LUDWIG | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 8168038887 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2865M2000X | 2000148145 | MO | Y | Hospitals | Military Hospital | Military General Acute Care Hospital |
No ID Information.