Provider Demographics
NPI:1215749189
Name:KANSAS MOBILE HEALTHCARE LLC
Entity type:Organization
Organization Name:KANSAS MOBILE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTIAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:316-249-7715
Mailing Address - Street 1:14748 SW 230TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASS
Mailing Address - State:KS
Mailing Address - Zip Code:67039-8127
Mailing Address - Country:US
Mailing Address - Phone:316-323-1400
Mailing Address - Fax:316-323-1402
Practice Address - Street 1:14748 SW 230TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLASS
Practice Address - State:KS
Practice Address - Zip Code:67039-8127
Practice Address - Country:US
Practice Address - Phone:316-323-1400
Practice Address - Fax:316-323-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1063801157Medicaid
KS1669498010Medicaid