| Prime Healthcare Physician Services - Providence Inc | |
|
3550 S 4th St Ste 100 Leavenworth KS 66048-5061 | |
| (913) 680-6200 | |
| (913) 680-6348 |
| Full Name | Prime Healthcare Physician Services - Providence Inc |
|---|---|
| Speciality | General Practice |
| Location | 3550 S 4th St Ste 100, Leavenworth, Kansas |
| Authorized Official Name and Position | David Dulny (PROVIDENCE CFO) |
| Authorized Official Contact | 8169435707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Healthcare Physician Services - Providence Inc 1000 Carondelet Dr Physician Billing Office Kansas City MO 64114 Ph: (816) 943-2283 | Prime Healthcare Physician Services - Providence Inc 3550 S 4th St Ste 100 Leavenworth KS 66048-5061 Ph: (913) 680-6200 |
| NPI Number | 1972119741 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 08/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972119741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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