Healthcare Provider Details

I. General information

NPI: 1598970790
Provider Name (Legal Business Name): SHAWNEE MISSION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

15980 COLLECTION CENTER DR
CHICAGO IL
60693-0159
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2214
  • Fax: 913-789-3106
Mailing address:
  • Phone: 913-234-1350
  • Fax: 913-234-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL TURNER
Title or Position: CEO
Credential:
Phone: 913-234-1350