Healthcare Provider Details

I. General information

NPI: 1245521814
Provider Name (Legal Business Name): JAYHAWK PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER ROAD KU MEDWEST THERAPY
SHAWNEE KS
66217-0000
US

IV. Provider business mailing address

7405 RENNER ROAD KU MEDWEST THERAPY
SHAWNEE KS
66217-0000
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-3506
  • Fax: 913-588-3508
Mailing address:
  • Phone: 913-588-3506
  • Fax: 913-588-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIAN S MILLS
Title or Position: MANAGER
Credential: OT
Phone: 913-588-3506