# PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1972119741
- **Legal business name:** PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
- **Authorized official:** DAVID DULNY (PROVIDENCE CFO)
- **Authorized official phone:** (913) 596-4835

## Contact information

- **Practice address:** 3550 S 4TH ST STE 100, LEAVENWORTH, KS 66048-5061
- **Practice address phone:** (913) 680-6200
- **Practice address fax:** (913) 680-6348
- **Mailing address:** 1000 CARONDELET DR, PHYSICIAN BILLING OFFICE, KANSAS CITY, MO 64114
- **Mailing address phone:** (816) 943-2283
- **Mailing address fax:** (816) 943-5762

## Taxonomy

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

## Other

- **Enumeration date:** 09/17/2020
- **Last updated:** 08/25/2025