Provider Demographics
NPI:1649475195
Name:JAYHAWK PRIMARY CARE INC
Entity type:Organization
Organization Name:JAYHAWK PRIMARY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PFS, ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-945-5603
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9856
Mailing Address - Fax:
Practice Address - Street 1:2650 SHAWNEE MISSION PKWY
Practice Address - Street 2:WESTWOOD INTERNAL MEDICINE, SUITE 2201
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2003
Practice Address - Country:US
Practice Address - Phone:913-588-9800
Practice Address - Fax:913-588-9803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYHAWK PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217070COtherJHPC KS MEDICAID GROUP#
KS100217070COtherJHPC KS MEDICAID GROUP#
KSJ610000AMedicare ID - Type UnspecifiedJHPC MEDICARE GROUP #