Provider Demographics
NPI:1578775151
Name:KANSAS UNIVERSITY PHYSICIANS INC
Entity Type:Organization
Organization Name:KANSAS UNIVERSITY PHYSICIANS INC
Other - Org Name:KU OPHTHALMIC FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-6626
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:913-588-6626
Mailing Address - Fax:913-588-6655
Practice Address - Street 1:7400 STATE LINE RD
Practice Address - Street 2:MAIL STOP 3009
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS UNIVERSITY PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21723019OtherBCBS KANSAS CITY ALT NUMB
KS026981OtherBCBS OF KANSAS
MO508653706Medicaid
KS100217430KMedicaid
MO21208023OtherBCBS OF KANSAS CITY
MO508653706Medicaid