Provider Demographics
NPI:1790742765
Name:JAYHAWK PRIMARY CARE INC
Entity Type:Organization
Organization Name:JAYHAWK PRIMARY CARE INC
Other - Org Name:FAMILY CARE OF INDEPENDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYRTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-9808
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9856
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:4721 S CLIFF AVE
Practice Address - Street 2:FAMILY CARE OF INDEPENDENCE SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7016
Practice Address - Country:US
Practice Address - Phone:816-503-3700
Practice Address - Fax:816-503-3704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYHAWK PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21211013OtherBCBS GROUP NUMBER
21211013OtherBCBS GROUP NUMBER
=========OtherJAYHAWK TAX ID