Provider Demographics
NPI:1558767624
Name:PRIME HEALTHCARE SERVICES KANSAS CITY, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES KANSAS CITY, LLC
Other - Org Name:ST. JOSEPH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-942-4400
Mailing Address - Fax:
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-942-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES KANSAS CITY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-17
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO287-37273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10156305Medicaid
KS100099610AMedicaid
440546292OtherTRICARE
KS100099610AMedicaid