Basic Information
| Provider Information | |||||||||
| NPI: | 1982665436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAYHAWK PRIMARY CARE INC | ||||||||
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| OtherOrganizationName: | THE UNIVERSITY OF KANSAS HEALTH SYSTEM-FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PKWY | ||||||||
| Address2: | MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE. 312 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889000 | ||||||||
| FaxNumber: | 9135889822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E 101ST TER | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641313366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167610884 | ||||||||
| FaxNumber: | 8167611790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | JORDAN | ||||||||
| AuthorizedOfficialFirstName: | CARRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9139455592 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JAYHAWK PRIMARY CARE INC | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 09470056 | 01 | MO | BCBS GROUP NUMBER | OTHER |