# PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRIME HEALTHCARE SERVICES, INC
- **Other names:** Providence Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356683213
- **Legal business name:** PRIME HEALTHCARE SERVICES, INC
- **Authorized official:** CHRISTOPHER DOAN (MANAGING ASSOCIATE GENERAL COUNSEL)
- **Authorized official phone:** (310) 259-4706

## Contact information

- **Practice address:** 16663 MIDLAND DR STE 100, SHAWNEE, KS 66217-3042
- **Practice address phone:** (913) 631-2600
- **Practice address fax:** (913) 631-2606
- **Mailing address:** 8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
- **Mailing address phone:** (913) 596-3930
- **Mailing address fax:** (913) 596-4098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | NULL | — |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | — |
| 2086S0120X | Pediatric Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2013
- **Last updated:** 08/25/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201193920H | — | KS |
| 05 | — | 500017218 | — | MO |