Kansas Medical Center, LLC
Organization Active NPI Family Medicine Physician · Derby, KS
NPI 1407237381 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1407237381
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- KANSAS MEDICAL CENTER, LLC
- Practice address
- 1410 N Woodlawn Blvd
Derby, KS 67037-2953 - Phone
- (316) 788-3741
- Fax
- (316) 788-5198
- NPI assigned
- Jun 16, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Steven Hadley
- Title
- Chief Business Executive
- Phone
- (316) 300-4000
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 3
Member organizations 1
Practitioners 3
-
Shelby Rae Brown, MSN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061109000659 | KS | Part B Supplier - Clinic/Group Practice | 2668476862 |
Receives reassigned benefits from 64 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Andover, KS; Wichita, KS; Neodosha, KS; Meade, KS; Liberal, KS; Kingman, KS; Independence, KS; Fredonia, KS… |
National Provider Directory
- Tax ID family
- Cypress Heart
Locations
1410 N Woodlawn Blvd
Derby, KS 67037
Phone (316) 788-3741
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/4D1ac_Ty5h2vV--oigqxzpJxwsTeHb_k/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | KS | Yes |
Addresses
Primary practice location
1410 N Woodlawn Blvd
Derby, KS 67037-2953
Mailing address
1410 N Woodlawn Blvd
Derby, KS 67037-2953
Phone (316) 788-3741
Other names
- Family Health Center
Other providers in Derby, KS
- David Robert Jowdy
- Jury Eye Care LLC
- Riena Kain
- Kansas Chiropractic Clinics, LLC
- Kansas CVS Pharmacy LLC
- Kasper Cousenling LLC
- Ty Kasper
- Ashley Keefover
- Ronald James Keller
- Amy S Kelley
All providers in Derby, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.