Provider Demographics
NPI:1215073143
Name:KANSAS UNIVERSITY PHYSICIANS INC
Entity type:Organization
Organization Name:KANSAS UNIVERSITY PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT TO THE CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-6146
Mailing Address - Street 1:3901RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6146
Mailing Address - Fax:
Practice Address - Street 1:5017 SUDLER HALL
Practice Address - Street 2:MAIL STOP 3016 3901 RAINBOW BLVD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANSAS UNIVERSITY PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS38287016OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KS026986OtherBCBS KS GRP NUMBER
MO501442008Medicaid
KS100088160DMedicaid
CC8801Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER
MO501442008Medicaid