Healthcare Provider Details

I. General information

NPI: 1417919283
Provider Name (Legal Business Name): JAYHAWK PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 N PROSPECT AVE
GLADSTONE MO
64119-1530
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: 913-945-9700
  • Fax: 913-945-9707
Mailing address:
  • Phone: 913-945-5614
  • Fax:

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: CARRIE JORDAN
Title or Position: CHIEF PRACTICE EXECUTIVE
Credential:
Phone: 913-945-5592