Provider Demographics
NPI:1982832895
Name:NICHOLAS BROCKERT MD AN OPERATING DIVISION OF SAINT JOHN HOSPITAL
Entity Type:Organization
Organization Name:NICHOLAS BROCKERT MD AN OPERATING DIVISION OF SAINT JOHN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PROVIDENCE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12406
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0406
Mailing Address - Country:US
Mailing Address - Phone:913-825-6512
Mailing Address - Fax:913-328-7011
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:913-651-3111
Practice Address - Fax:913-651-3103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOHN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty