PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC NPI 1356683213

NPI Information

PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC is a general practice in Shawnee, KS. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC NPI is 1356683213. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Medical Group.

The provider's business location address is:

16663 MIDLAND DR STE 100
SHAWNEE, KS
ZIP 66217-042
Phone: (913) 631-2600
Fax: (913) 631-2606

The provider's authorized official is Christopher Doan .
The authorized official title is Managing Associate General Counsel and has the following contact phone number (310) 259-4706.

The CLIA number assigned to this NPI record is 17D2017217 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/19/2013 and was last updated on 8/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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