Provider Demographics
NPI:1972119741
Name:PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
Entity type:Organization
Organization Name:PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDENCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DULNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-943-5707
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:PHYSICIAN BILLING OFFICE
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-2283
Mailing Address - Fax:816-943-5762
Practice Address - Street 1:3550 S 4TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5061
Practice Address - Country:US
Practice Address - Phone:913-680-6200
Practice Address - Fax:913-680-6348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty