Provider Demographics
NPI:1689710519
Name:KANSAS UNIVERSITY PHYSICIANS INC
Entity Type:Organization
Organization Name:KANSAS UNIVERSITY PHYSICIANS INC
Other - Org Name:KU RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-6830
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:913-588-6830
Mailing Address - Fax:
Practice Address - Street 1:2162 KU MEDICAL CENTER
Practice Address - Street 2:MAIL STOP 4032 3901RAINBOW BLVD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS UNIVERSITY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217430DMedicaid
MO01506027OtherBCBS KC GRP NUMBER
MO710923905Medicaid
KS060327OtherBCBS KS GRP NUMBER
KS100217430DMedicaid
KS060327OtherBCBS KS GRP NUMBER