Provider Demographics
NPI:1316048176
Name:MERCY KANSAS COMMUNITIES, INC
Entity type:Organization
Organization Name:MERCY KANSAS COMMUNITIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-625-2459
Mailing Address - Street 1:403 WOODLAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8798
Mailing Address - Country:US
Mailing Address - Phone:620-223-8040
Mailing Address - Fax:620-223-8534
Practice Address - Street 1:403 WOODLAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8798
Practice Address - Country:US
Practice Address - Phone:620-223-8040
Practice Address - Fax:620-223-8534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY KANSAS COMMUNITIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24746207Q00000X
KS17312207Q00000X
KS18448207Q00000X
KS31674207V00000X
KS22858208600000X
KS04-25914208000000X, 207R00000X
KS04-32360208600000X
KS45086363LF0000X
KS04-33417207XX0005X
KS44801363LF0000X
KS45022363LF0000X
KS75331363L00000X
KS04-34210207Q00000X
KS04-30826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3212950001Medicare NSC
KS110135Medicare PIN