Provider Demographics
NPI:1942463575
Name:JAYHAWK FOOT AND ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:JAYHAWK FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-284-1555
Mailing Address - Street 1:9300 MEADOW VIEW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227
Mailing Address - Country:US
Mailing Address - Phone:913-871-2183
Mailing Address - Fax:913-780-4834
Practice Address - Street 1:9300 MEADOW VIEW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227
Practice Address - Country:US
Practice Address - Phone:913-871-2183
Practice Address - Fax:913-780-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200368213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty