Healthcare Provider Details

I. General information

NPI: 1477860112
Provider Name (Legal Business Name): PROVIDENCE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 PARALLEL PKWY
KANSAS CITY KS
66112-1689
US

IV. Provider business mailing address

PO BOX 413923
KANSAS CITY MO
64141-3923
US

V. Phone/Fax

Practice location:
  • Phone: 785-295-5307
  • Fax: 785-231-5991
Mailing address:
  • Phone: 785-295-5307
  • Fax: 785-231-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CURT V LANDIS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 785-295-8219