Provider Demographics
NPI:1952585341
Name:KANSAS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:KANSAS MEDICAL CENTER, LLC
Other - Org Name:ANDOVER CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-300-4021
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0195
Mailing Address - Country:US
Mailing Address - Phone:316-300-4021
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:1124 W 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-5500
Practice Address - Country:US
Practice Address - Phone:316-300-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-21
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200408390EMedicaid
KS111401OtherBCBSKS
KSKA1041Medicare PIN