Provider Demographics
NPI:1295845758
Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Other - Org Name:KU DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-9000
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:4720 RAINBOW BLVD
Practice Address - Street 2:KU DENTAL ASSOCIATES, STE. 250
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1831
Practice Address - Country:US
Practice Address - Phone:913-588-9200
Practice Address - Fax:913-588-9203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
452100OtherBCBS KS GROUP NUMBER
36950011OtherBCBS KC GROUP NUMBER
36950011OtherBCBS KC GROUP NUMBER
=========OtherPSKU TAX ID