Provider Demographics
NPI:1407237381
Name:KANSAS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:KANSAS MEDICAL CENTER, LLC
Other - Org Name:FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXCECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-300-4000
Mailing Address - Street 1:1410 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2953
Mailing Address - Country:US
Mailing Address - Phone:316-788-3741
Mailing Address - Fax:316-788-5198
Practice Address - Street 1:1410 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2953
Practice Address - Country:US
Practice Address - Phone:316-788-3741
Practice Address - Fax:316-788-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty