Provider Demographics
NPI:1942317854
Name:SHAWNEE MISSION MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SHAWNEE MISSION MEDICAL CENTER, INC.
Other - Org Name:ADVENTHEALTH CENTRA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC 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 1:11245 SHAWNEE MISSION PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-3333
Mailing Address - Country:US
Mailing Address - Phone:913-268-4455
Mailing Address - Fax:913-268-4493
Practice Address - Street 1:11245 SHAWNEE MISSION PARKWAY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-3333
Practice Address - Country:US
Practice Address - Phone:913-268-4455
Practice Address - Fax:913-268-4493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MISSION MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK210000Medicare PIN