Provider Demographics
NPI:1578178521
Name:SHAWNEE MISSION MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SHAWNEE MISSION MEDICAL CENTER, INC.
Other - Org Name:ADVENTHEALTH IMAGING CENTER ROELAND PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAIRILISE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTHIN OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-676-2153
Mailing Address - Street 1:7315 E FRONTAGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1658
Mailing Address - Country:US
Mailing Address - Phone:913-676-2488
Mailing Address - Fax:
Practice Address - Street 1:5675 ROE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2515
Practice Address - Country:US
Practice Address - Phone:913-676-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology