Provider Demographics
NPI:1740313634
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:DIRECTOR OF PHYSICIAN REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-6711
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:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:4810 STATE AVE
Practice Address - Street 2:STATE AVENUE THERAPY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1748
Practice Address - Country:US
Practice Address - Phone:913-321-4567
Practice Address - Fax:913-321-6789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYHAWK PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherJHPC TAX ID
KSJ610000AMedicare ID - Type UnspecifiedJHPC MEDICARE GROUP #