Healthcare Provider Details

I. General information

NPI: 1619407665
Provider Name (Legal Business Name): SHAWNEE MISSION MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 NE RICE RD
LEES SUMMIT MO
64086-5540
US

IV. Provider business mailing address

7315 E FRONTAGE RD STE 101
MERRIAM KS
66204-1658
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-1518
  • Fax: 816-554-8710
Mailing address:
  • Phone: 913-789-3938
  • Fax: 913-789-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: KARSTEN RANDOLPH
Title or Position: CFO & EVP
Credential:
Phone: 913-676-2152