1982845970 NPI number — JAYHAWK PRIMARY CARE INC

Table of content: (NPI 1982845970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982845970 NPI number — JAYHAWK PRIMARY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAYHAWK PRIMARY CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL PLAZA INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982845970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 SHAWNEE MISSION PKWY
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE.312
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-945-5614
Provider Business Mailing Address Fax Number:
913-945-5617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10787 NALL AVE
Provider Second Line Business Practice Location Address:
STE. 310
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-945-6900
Provider Business Practice Location Address Fax Number:
913-945-6970
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
913-945-5603

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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