Provider Demographics
NPI:1801007786
Name:KANSAS MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:KANSAS MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF BUSINESS EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-300-4021
Mailing Address - Street 1:PO BOX 268938
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8938
Mailing Address - Country:US
Mailing Address - Phone:316-300-4021
Mailing Address - Fax:316-300-4040
Practice Address - Street 1:1124 W. 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-300-4000
Practice Address - Fax:316-300-4040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDN3967OtherRR MEDICARE
KS111283OtherBSBSKS
KS200408390BMedicaid
KS111283Medicare PIN