Organization
PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
Active
Parent organization
PRIME HEALTHCARE SERVICES, INC
Other names
Providence Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIME HEALTHCARE SERVICES, INC
Authorized official
CHRISTOPHER DOAN (MANAGING ASSOCIATE GENERAL COUNSEL)
(310) 259-4706
Entity
Organization
Contact information
Practice address
16663 MIDLAND DR STE 100, SHAWNEE, KS 66217-3042
(913) 631-2600
(913) 631-2606
Mailing address
8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-3930
(913) 596-4098
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0120X
Pediatric Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201193920H
—
KS
05
—
500017218
—
MO
Enumeration date
03/19/2013
Last updated
08/25/2025
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