Healthcare Provider Details

I. General information

NPI: 1801007786
Provider Name (Legal Business Name): KANSAS MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W. 21ST ST
ANDOVER KS
67002
US

IV. Provider business mailing address

PO BOX 268938
OKLAHOMA CITY OK
73126-8938
US

V. Phone/Fax

Practice location:
  • Phone: 316-300-4000
  • Fax: 316-300-4040
Mailing address:
  • Phone: 316-300-4021
  • Fax: 316-300-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. STEVEN HADLEY
Title or Position: CHIEF BUSINESS EXECUTIVE
Credential:
Phone: 316-300-4021