Basic Information
| Provider Information | |||||||||
| NPI: | 1942317854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWNEE MISSION MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTHEALTH CENTRA CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11245 SHAWNEE MISSION PARKWAY | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662033333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132684455 | ||||||||
| FaxNumber: | 9132684493 | ||||||||
| Practice Location | |||||||||
| Address1: | 11245 SHAWNEE MISSION PARKWAY | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662033333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132684455 | ||||||||
| FaxNumber: | 9132684493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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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 | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.