Healthcare Provider Details

I. General information

NPI: 1528025053
Provider Name (Legal Business Name): JAYHAWK PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER RD KU MEDWEST
SHAWNEE KS
66217-9414
US

IV. Provider business mailing address

2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE. 312
WESTWOOD KS
66205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-8400
  • Fax: 913-588-8413
Mailing address:
  • Phone: 913-588-9000
  • Fax: 913-588-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BROWN
Title or Position: BILLING DIRECTOR
Credential:
Phone: 913-945-5603