Basic Information
| Provider Information | |||||||||
| NPI: | 1407023195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | JOHNSON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 W 70TH TER | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162684874 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4801 E LINWOOD BLVD | ||||||||
| Address2: | CARDIAC CATH LAB | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641282226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168614700 | ||||||||
| FaxNumber: | 8169223324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C1101X | 151431 | LA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Cardiovascular-Interventional Technology |
No ID Information.