Basic Information
| Provider Information | |||||||||
| NPI: | 1477860112 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVIDENCE CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 413923 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641413923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955307 | ||||||||
| FaxNumber: | 7852315991 | ||||||||
| Practice Location | |||||||||
| Address1: | 8929 PARALLEL PKWY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661121689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955307 | ||||||||
| FaxNumber: | 7852315991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | LANDIS | ||||||||
| AuthorizedOfficialFirstName: | CURT | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7852958219 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RH0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.