Organization
PROVIDENCE MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DORSEY (INTERIM CHIEF EXECUTIVE OFFICER)
(913) 596-4882
Entity
Organization
Contact information
Practice address
8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-4000
Mailing address
8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-4000
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
H105003
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000729
BLUE CROSS OF KANSAS
KS
01
—
323130
FIRST GUARD
KS
01
—
71980
AETNA
KS
01
—
90051016
BLUE CROSS OF KANSAS CITY
KS
Enumeration date
07/29/2005
Last updated
08/22/2020
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