Provider Demographics
NPI:1265804751
Name:UNIVERSITY OF KANSAS HOSPITAL
Entity type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNAFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:816-806-7406
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-7603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7603
Practice Address - Country:US
Practice Address - Phone:913-588-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01894281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital