1801896915 NPI number — PROVIDENCE MEDICAL CENTER, INC

Table of content: (NPI 1801896915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801896915 NPI number — PROVIDENCE MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE MEDICAL CENTER, 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:
Provider Other Organization Name Type Code:
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:
1801896915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8929 PARALLEL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-596-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8929 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DORSEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
913-596-4882

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H105003 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71980 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 90051016 . This is a "BLUE CROSS OF KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 323130 . This is a "FIRST GUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 000729 . This is a "BLUE CROSS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".