Provider Demographics
NPI:1629186424
Name:DR MARTHA L HURLEY AN OPERATING DIVISION OF SAINT JOHN HOSPITAL
Entity Type:Organization
Organization Name:DR MARTHA L HURLEY AN OPERATING DIVISION OF SAINT JOHN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PROVIDENCE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:3601 S 4TH ST
Mailing Address - Street 2:1
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5015
Mailing Address - Country:US
Mailing Address - Phone:913-682-2600
Mailing Address - Fax:913-682-2622
Practice Address - Street 1:3601 S 4TH ST
Practice Address - Street 2:1
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5015
Practice Address - Country:US
Practice Address - Phone:913-682-2600
Practice Address - Fax:913-682-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C17250Medicare UPIN