| Northeast Kansas Gi Consultants Pa | |
|
3601 S 4th St Suite 5 Leavenworth KS 66048-5015 | |
| (913) 220-5193 | |
| (913) 814-9989 |
| Full Name | Northeast Kansas Gi Consultants Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3601 S 4th St, Leavenworth, Kansas |
| Authorized Official Name and Position | Srinivasa Rao G. Vasa (OWNER) |
| Authorized Official Contact | 9132205193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Kansas Gi Consultants Pa 3601 S 4th St Suite 5 Leavenworth KS 66048-5015 Ph: (913) 220-5193 | Northeast Kansas Gi Consultants Pa 3601 S 4th St Suite 5 Leavenworth KS 66048-5015 Ph: (913) 220-5193 |
| NPI Number | 1326080755 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 03/26/2014 |
| Medicare PECOS PAC ID | 5294791125 |
|---|---|
| Medicare Enrollment ID | O20041202000761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326080755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 04-27796 (Kansas) | Primary |
| Provider Name | Srinivasa Rao G Vasa |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1457398190 PECOS PAC ID: 8123011061 Enrollment ID: I20041203000224 |
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