Provider Demographics
NPI:1427160514
Name:HEART AND VASCULAR CARE, P. C.
Entity type:Organization
Organization Name:HEART AND VASCULAR CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-782-2190
Mailing Address - Street 1:2817 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1629
Mailing Address - Country:US
Mailing Address - Phone:417-782-2190
Mailing Address - Fax:417-782-6750
Practice Address - Street 1:2817 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-782-2190
Practice Address - Fax:417-782-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200004960AMedicaid
KS100458760AMedicaid
MO506041805Medicaid
MOMA1226Medicare PIN
KS9004186Medicare PIN
MOMA1227Medicare PIN
OK400522296Medicare PIN
MO506041805Medicaid
KS100458760AMedicaid
KS130543Medicare PIN