Provider Demographics
NPI:1912875600
Name:PRIME HEALTHCARE SERVICES - SAINT JOHN LEAVENWORTH LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - SAINT JOHN LEAVENWORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-4706
Mailing Address - Street 1:3550 S 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5009
Mailing Address - Country:US
Mailing Address - Phone:913-680-6442
Mailing Address - Fax:913-680-6425
Practice Address - Street 1:3550 S 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5009
Practice Address - Country:US
Practice Address - Phone:913-680-6442
Practice Address - Fax:913-680-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health