Provider Demographics
NPI:1841600095
Name:FULTON MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:FULTON MEDICAL CENTER LLC
Other - Org Name:FULTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE CHAIR, NUEHEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TASSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-387-0510
Mailing Address - Street 1:11221 ROE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1922
Mailing Address - Country:US
Mailing Address - Phone:913-387-0510
Mailing Address - Fax:
Practice Address - Street 1:850 N HOSPITAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2535
Practice Address - Country:US
Practice Address - Phone:573-642-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health