Basic Information
| Provider Information | |||||||||
| NPI: | 1134121379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH ADMINISOURCE, L.L.C. | ||||||||
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| OtherOrganizationName: | KANSAS CITY PHYSICAL THERAPY GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5799 BROADMOOR ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133845600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5799 BROADMOOR ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133845600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 11/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUNCAN | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9133845600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 14112990 | 01 | KS | U.S. DEPT OF LABOR | OTHER | 731060 | 01 | HEALTHCARE PREFERRED | OTHER | 8271336 | 01 | AETNA PROVIDER NUMBER | OTHER | 16278037 | 01 | BLUE CROSS BLUE SHIELD | OTHER | T660000A | 01 | MO | MEDICARE PART B | OTHER | 4000127 | 01 | MULTIPLAN PROVIDER NUMBER | OTHER | T660000 | 01 | KS | MEDICARE PART B | OTHER | 14112991 | 01 | MO | U.S. DEPT OF LABOR | OTHER | 440660 | 01 | HEALTHLINK PROVIDER NUMBE | OTHER | 534021 | 01 | KS | BLUE CROSS BLUE SHIELD KS | OTHER | 6400222 | 01 | UNITED HEALTHCARE PROVIDE | OTHER |