Provider Demographics
NPI:1417919283
Name:JAYHAWK PRIMARY CARE INC
Entity Type:Organization
Organization Name:JAYHAWK PRIMARY CARE INC
Other - Org Name:CREEKWOOD FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PRACTICE EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-945-5592
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:913-945-5614
Mailing Address - Fax:
Practice Address - Street 1:6420 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-1530
Practice Address - Country:US
Practice Address - Phone:913-945-9700
Practice Address - Fax:913-945-9707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYHAWK PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10663011OtherBCBS GROUP NUMBR
=========OtherJAYHAWK TAX ID
MOJ610000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER