Basic Information
| Provider Information | |||||||||
| NPI: | 1932460177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAYHAWK PRIMARY CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INDIAN CREEK PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PKWY | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139455614 | ||||||||
| FaxNumber: | 9139455617 | ||||||||
| Practice Location | |||||||||
| Address1: | 10777 NALL AVE | ||||||||
| Address2: | STE 140 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137544599 | ||||||||
| FaxNumber: | 9137543996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 06/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9139455603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.