Healthcare Provider Details

I. General information

NPI: 1134121379
Provider Name (Legal Business Name): HEALTH ADMINISOURCE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5799 BROADMOOR ST STE 300
MISSION KS
66202-2421
US

IV. Provider business mailing address

5799 BROADMOOR ST STE 300
MISSION KS
66202-2421
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-5600
  • Fax:
Mailing address:
  • Phone: 913-384-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier14112990
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerU.S. DEPT OF LABOR
# 2
Identifier731060
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHCARE PREFERRED
# 3
Identifier8271336
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA PROVIDER NUMBER
# 4
Identifier16278037
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS BLUE SHIELD
# 5
IdentifierT660000A
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMEDICARE PART B
# 6
Identifier4000127
Identifier TypeOTHER
Identifier State
Identifier IssuerMULTIPLAN PROVIDER NUMBER
# 7
IdentifierT660000
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerMEDICARE PART B
# 8
Identifier14112991
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerU.S. DEPT OF LABOR
# 9
Identifier440660
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHLINK PROVIDER NUMBE
# 10
Identifier534021
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBLUE CROSS BLUE SHIELD KS
# 11
Identifier6400222
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE PROVIDE

VIII. Authorized Official

Name: ANGELA A DUNCAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 913-384-5600