Provider Demographics
NPI:1407304256
Name:KANSAS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:KANSAS MEDICAL CENTER, LLC
Other - Org Name:KMC PHYSICIANS PART A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF BUSINESS EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-300-4000
Mailing Address - Street 1:1124 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-5500
Mailing Address - Country:US
Mailing Address - Phone:316-300-4000
Mailing Address - Fax:316-300-4040
Practice Address - Street 1:1124 W 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-5500
Practice Address - Country:US
Practice Address - Phone:316-300-4000
Practice Address - Fax:316-300-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-008-003282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS170197Medicare PIN