Provider Demographics
NPI:1255380127
Name:KANSAS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:KANSAS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BADR
Authorized Official - Middle Name:
Authorized Official - Last Name:IDBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-300-4021
Mailing Address - Street 1:1124 W 21ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-5500
Mailing Address - Country:US
Mailing Address - Phone:316-300-4000
Mailing Address - Fax:316-300-4040
Practice Address - Street 1:1124 W 21ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-5500
Practice Address - Country:US
Practice Address - Phone:316-300-4000
Practice Address - Fax:316-300-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
KSH008003282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200408390CMedicaid