Healthcare Provider Details

I. General information

NPI: 1194000570
Provider Name (Legal Business Name): PHOENIX HEALTHCARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11029 HAUSER STREET
LENEXA KS
66210
US

IV. Provider business mailing address

11029 HAUSER STREET
LENEXA KS
66210
US

V. Phone/Fax

Practice location:
  • Phone: 913-851-0500
  • Fax: 913-851-0502
Mailing address:
  • Phone: 913-851-0500
  • Fax: 913-851-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANA C HANSON
Title or Position: CO-OWNER APRN
Credential: APRN
Phone: 913-851-0500