Provider Demographics
NPI:1841773934
Name:COVENTRY HEALTHCARE OF KANSAS
Entity Type:Organization
Organization Name:COVENTRY HEALTHCARE OF KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-202-5142
Mailing Address - Street 1:9401 INDIAN CREEK PKWY STE 1300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2021
Mailing Address - Country:US
Mailing Address - Phone:913-202-5142
Mailing Address - Fax:
Practice Address - Street 1:9401 INDIAN CREEK PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2021
Practice Address - Country:US
Practice Address - Phone:913-202-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0Medicaid
KS201212390AMedicaid