Provider Demographics
NPI:1346386265
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:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-6728
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3010
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6701
Mailing Address - Fax:913-588-0107
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 3010
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6731
Practice Address - Fax:913-588-0107
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:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503030702Medicaid
KS026947OtherBCBS KS GRP NUMBER
KS100217430NMedicaid
MO00573038OtherBCBS KC GRP NUMBER
MO503030702Medicaid
MO00573038OtherBCBS KC GRP NUMBER