Basic Information
| Provider Information | |||||||||
| NPI: | 1114928108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS HEART HOSPITAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 N WEBB RD. | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672268129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166305000 | ||||||||
| FaxNumber: | 3166305050 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 N WEBB RD. | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672268129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166305000 | ||||||||
| FaxNumber: | 3166305050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 05/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | ASHCOM | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3166305000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H087009 | KS | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100340110A | 05 | KS | MEDICAID |