# PROVIDENCE CARE AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700921970
- **Legal business name:** PROVIDENCE MEDICAL CENTER
- **Authorized official:** RANDALL G NYP (PRESIDENT/CEO)
- **Authorized official phone:** (913) 596-4000

## Contact information

- **Practice address:** 913 SHEIDLEY AVE, BONNER SPRINGS, KS 66012-9514
- **Practice address phone:** (913) 322-7222
- **Practice address fax:** (913) 322-7284
- **Mailing address:** DEPT CH 14363, PALATINE, IL 60055-4363
- **Mailing address phone:** (785) 295-8108
- **Mailing address fax:** (785) 270-7646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 04/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200429440A | — | KS |
| 01 | — | 37765011 | BCBS KANSAS CITY | KS |
| 01 | — | DF7207 | RAILROAD MEDICARE | KS |
| 01 | — | X150000 | MEDICARE KANSAS CITY | KS |