Organization
PROVIDENCE CARE AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Active
Parent organization
PROVIDENCE MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE MEDICAL CENTER
Authorized official
RANDALL G NYP (PRESIDENT/CEO)
(913) 596-4000
Entity
Organization
Contact information
Practice address
913 SHEIDLEY AVE, BONNER SPRINGS, KS 66012-9514
(913) 322-7222
(913) 322-7284
Mailing address
DEPT CH 14363, PALATINE, IL 60055-4363
(785) 295-8108
(785) 270-7646
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
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
Enumeration date
02/21/2007
Last updated
04/20/2012
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