Provider Demographics
NPI:1760705156
Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Other - Org Name:MISSYS' BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-945-5469
Mailing Address - Street 1:2330 SHAWNEE MISSION PARKWAY
Mailing Address - Street 2:STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-0000
Mailing Address - Country:US
Mailing Address - Phone:913-945-5614
Mailing Address - Fax:913-945-5617
Practice Address - Street 1:2330 SHAWNEE MISSION PARKWAY STE. 2200
Practice Address - Street 2:MISSYS' BOUTIQUE
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2005
Practice Address - Country:US
Practice Address - Phone:913-945-5800
Practice Address - Fax:913-945-5802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-12
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0777500002Medicare NSC