Basic Information
| Provider Information | |||||||||
| NPI: | 1902326887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWNEE MISSION MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SM URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7315 E FRONTAGE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662041658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137893938 | ||||||||
| FaxNumber: | 9137893867 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 QUIVIRA RD | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138881151 | ||||||||
| FaxNumber: | 9138881822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2017 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | RANDOLPH | ||||||||
| AuthorizedOfficialFirstName: | KARSTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO & EVP | ||||||||
| 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 | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.