Basic Information
| Provider Information | |||||||||
| NPI: | 1356382337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLATHE MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | OLATHE HEALTH HOSPICE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20333 W 151ST ST | ||||||||
| Address2: | ATTN OLATHE HEALTH HOSPICE CARE | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137914461 | ||||||||
| FaxNumber: | 9137918656 | ||||||||
| Practice Location | |||||||||
| Address1: | 20920 W 151ST ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660617247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133248515 | ||||||||
| FaxNumber: | 9133248597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | GRASSER | ||||||||
| AuthorizedOfficialFirstName: | TIERNEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9137914461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OLATHE MEDICAL CENTER INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | A046041 | KS | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 100099250C | 05 | KS | MEDICAID |