Provider Demographics
NPI:1457497364
Name:KANSAS UNIVERSITY PHYSICIANS INC
Entity Type:Organization
Organization Name:KANSAS UNIVERSITY PHYSICIANS INC
Other - Org Name:KU FAMILY MEDICINE FOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-1944
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-1944
Mailing Address - Fax:
Practice Address - Street 1:1130 DELP PAVILION
Practice Address - Street 2:MAIL STOP 4010 3901 RAINBOW BLVD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-1944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS UNIVERSITY PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508632106Medicaid
MO00080029OtherBCBS KC GRP NUMER
KS026961OtherBCBS KS GRP NUMBER
KS100217430LMedicaid
KS100217430LMedicaid
CC8801Medicare ID - Type UnspecifiedRAILROAD MEDICARE