Provider Demographics
NPI:1326551144
Name:SHAWNEE MISSION MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SHAWNEE MISSION MEDICAL CENTER INC
Other - Org Name:SPIRA CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-676-2152
Mailing Address - Street 1:7315 E FRONTAGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15710 W 135TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1508
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MISSION MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty