Provider Demographics
NPI:1750323937
Name:SHAWNEE MISSION MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SHAWNEE MISSION MEDICAL CENTER INC
Other - Org Name:SHAWNEE MISSION HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARSTEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-676-2152
Mailing Address - Street 1:7312 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2739
Mailing Address - Country:US
Mailing Address - Phone:913-676-2163
Mailing Address - Fax:913-676-2363
Practice Address - Street 1:7312 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2739
Practice Address - Country:US
Practice Address - Phone:913-676-2163
Practice Address - Fax:913-676-2363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MISSION MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSAO46138251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS90003016OtherBLUE CROSS BLUE SHIELD KA
KS178058OtherUNITED HEALTHCARE
KS178058OtherCOVENTRY HEALTH LIFE MCR
KS178058OtherHUMANA GOLD CHC KC MCR
KS178058Medicare ID - Type Unspecified