Provider Demographics
NPI:1659490126
Name:NATIONWIDE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:NATIONWIDE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-631-3844
Mailing Address - Street 1:11111 W 59TH TER
Mailing Address - Street 2:STE 103
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2713
Mailing Address - Country:US
Mailing Address - Phone:913-631-3844
Mailing Address - Fax:
Practice Address - Street 1:6538 HALLET ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2209
Practice Address - Country:US
Practice Address - Phone:913-631-0538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA046146251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health