Healthcare Provider Details

I. General information

NPI: 1962306449
Provider Name (Legal Business Name): ADVENTHEALTH PRIMARY CARE PLUS OF KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 W 18TH ST
LAWRENCE KS
66047-2090
US

IV. Provider business mailing address

2600 WESTHALL LN STE 300
MAITLAND FL
32751-7107
US

V. Phone/Fax

Practice location:
  • Phone: 785-830-0100
  • Fax: 785-830-0100
Mailing address:
  • Phone:
  • Fax: 407-200-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DESTIN HARCUS
Title or Position: CFO
Credential:
Phone: 225-328-1607