| Providence Care An Operating Division Of Providence Medical Ctr | |
|
913 Sheidley Ave Bonner Springs KS 66012-9514 | |
| (913) 322-7222 | |
| (913) 322-7284 |
| Full Name | Providence Care An Operating Division Of Providence Medical Ctr |
|---|---|
| Speciality | General Practice |
| Location | 913 Sheidley Ave, Bonner Springs, Kansas |
| Authorized Official Name and Position | Randall G Nyp (PRESIDENT/CEO) |
| Authorized Official Contact | 9135964000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Care An Operating Division Of Providence Medical Ctr Dept Ch 14363 Palatine IL 60055-4363 Ph: (785) 295-8108 | Providence Care An Operating Division Of Providence Medical Ctr 913 Sheidley Ave Bonner Springs KS 66012-9514 Ph: (913) 322-7222 |
| NPI Number | 1700921970 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 04/20/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700921970 | NPI | - | NPPES |
| 37765011 | Other | KS | BCBS KANSAS CITY |
| DF7207 | Other | KS | RAILROAD MEDICARE |
| 200429440A | Medicaid | KS | |
| X150000 | Other | KS | MEDICARE KANSAS CITY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
Pure Movement Integrated Health Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 13100 Kansas Ave Ste C, Bonner Springs, KS 66012 Phone: 913-745-4036 Fax: 913-745-4334 |