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General NPI Number Information
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NPI Number | 1912875600
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES - SAINT JOHN LEAVENWORTH LLC
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Dates
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Enumeration Date | 10/25/2025
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Last Update Date | 10/25/2025
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Provider Practice Location Address
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Address Line | 3550 S 4TH ST STE 200
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5009
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Country | US
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Telephone | 913-680-6442
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Fax | 913-680-6425
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Provider Business Mailing Address
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Address Line | 3550 S 4TH ST STE 200
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5009
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Country | US
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Telephone | 913-680-6442
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Fax | 913-680-6425
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Authorized Official
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Title or Position | MANAGING ASSOCIATE GENERAL COUNSEL
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Name | CHRISTOPHER DOAN
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Credential |
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Telephone | 310-259-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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