Healthcare Provider Details

I. General information

NPI: 1629186424
Provider Name (Legal Business Name): DR MARTHA L HURLEY AN OPERATING DIVISION OF SAINT JOHN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 4TH ST 1
LEAVENWORTH KS
66048-5015
US

IV. Provider business mailing address

3601 S 4TH ST 1
LEAVENWORTH KS
66048-5015
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2600
  • Fax: 913-682-2622
Mailing address:
  • Phone: 913-682-2600
  • Fax: 913-682-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES T PAQUETTE
Title or Position: CEO, PROVIDENCE HEALTH
Credential:
Phone: 913-596-4000