Provider Demographics
NPI:1326383274
Name:JAYHAWK PRIMARY CARE INC
Entity Type:Organization
Organization Name:JAYHAWK PRIMARY CARE INC
Other - Org Name:STATE AVENUE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-945-9740
Mailing Address - Street 1:4810 STATE AVE
Mailing Address - Street 2:STATE AVENUE HEALTH CARE
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1748
Mailing Address - Country:US
Mailing Address - Phone:913-945-9740
Mailing Address - Fax:913-945-9741
Practice Address - Street 1:4810 STATE AVE
Practice Address - Street 2:STATE AVENUE HEALTH CARE
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1748
Practice Address - Country:US
Practice Address - Phone:913-945-9740
Practice Address - Fax:913-945-9741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYHAWK PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty