Provider Demographics
NPI:1437202082
Name:SM CORPORATE CARE LLC
Entity Type:Organization
Organization Name:SM CORPORATE CARE LLC
Other - Org Name:CORPORATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARSTEN
Authorized Official - Middle Name:G
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
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1658
Mailing Address - Country:US
Mailing Address - Phone:913-676-2489
Mailing Address - Fax:913-676-2680
Practice Address - Street 1:9040 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3902
Practice Address - Country:US
Practice Address - Phone:913-492-9675
Practice Address - Fax:913-438-8726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MISSION MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty