1073896874 NPI number — UNIVERSITY OF KANSAS HOSPITAL AUTHORITY

Table of content: (NPI 1073896874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073896874 NPI number — UNIVERSITY OF KANSAS HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
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:
Provider Other Organization Name Type Code:
6
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:
1073896874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ATTN: RETAIL PHARMACY SOUTH
Provider Second Line Business Mailing Address:
9200 INDIAN CREEK PRKWY, BLDG 9, SUITE 300
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-541-4651
Provider Business Mailing Address Fax Number:
913-577-5851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E 101ST TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-823-6635
Provider Business Practice Location Address Fax Number:
816-841-1242
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY SERVICES MANAGER
Authorized Official Telephone Number:
913-541-4651

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2011017761 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2131972 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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