Provider Demographics
NPI:1225177140
Name:JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC
Other - Org Name:JANE PHILLIPS MEDCARE PHARMACY - INDEPENDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-330-8282
Mailing Address - Street 1:800 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3211
Mailing Address - Country:US
Mailing Address - Phone:620-330-8282
Mailing Address - Fax:620-330-8284
Practice Address - Street 1:800 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3211
Practice Address - Country:US
Practice Address - Phone:620-330-8282
Practice Address - Fax:620-330-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-132183336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099630FMedicaid