Provider Demographics
NPI:1043237894
Name:PROVIDENCE URGENT CARE CENTER
Entity Type:Organization
Organization Name:PROVIDENCE URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:8929 PARALLEL PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1689
Mailing Address - Country:US
Mailing Address - Phone:913-596-4000
Mailing Address - Fax:
Practice Address - Street 1:22334 W 66TH ST SPC 10
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3560
Practice Address - Country:US
Practice Address - Phone:913-825-0909
Practice Address - Fax:913-825-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS36051011OtherBLUE CROSS BLUE SHIELD GR
KSDD9110Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KST250000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER