Basic Information
| Provider Information | |||||||||
| NPI: | 1437202082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SM CORPORATE CARE LLC | ||||||||
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| OtherOrganizationName: | CORPORATE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7315 E. FRONTAGE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662041658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136762489 | ||||||||
| FaxNumber: | 9136762680 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 QUIVIRA RD | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134929675 | ||||||||
| FaxNumber: | 9134388726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | RANDOLPH | ||||||||
| AuthorizedOfficialFirstName: | KARSTEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 9136762152 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHAWNEE MISSION MEDICAL CENTER INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2083P0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.