PROVIDENCE CARE AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR (NPI# 1700921970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700921970 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE CARE AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR |
| Practice Address |
913 Sheidley Ave Bonner Springs KS 66012-9514 |
| Mailing Address |
Dept Ch 14363 Palatine IL 60055-4363 |
| Practice Telephone | 9133227222 |
| Practice Fax Number | 9133227284 |
| Mailing Telephone | 7852958108 |
| Mailing Fax Number | 7852707646 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2012-04-20 |
| Authorized Official Name | RANDALL G NYP (PRESIDENT/CEO) |
| Authorized Official Telephone | 9135964000 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | MEDICARE KANSAS CITY | X150000 | 01 |
| KS | BCBS KANSAS CITY | 37765011 | 01 |
| KS | RAILROAD MEDICARE | DF7207 | 01 |
| KS | 200429440A | 05 |
| Street Address |
913 SHEIDLEY AVE |
| City | BONNER SPRINGS |
| State | KS |
| Zip Code | 66012-9514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679666077 | Sandra Y Suderman | Nurse Practitioner | 913 Sheidley Ave, Bonner Springs, KS 66012-9514 | 2006-09-30 |
| 1639376809 | Ann Elizabeth Kurtz | Family Medicine | 913 Sheidley Ave, Bonner Springs, KS 66012-9514 | 2007-06-29 |
| 1669554176 | Stephen Patrick Thies | Family Medicine | 913 Sheidley Ave, Bonner Springs, KS 66012-9514 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265834485 | Tamara Sipe | Nurse Anesthetist, Certified Registered | 16321 Stillwell Rd, Bonner Springs, KS 66012 | 2014-09-18 |
| 1558564575 | Sunflower Healthcare, Inc | Hospice Care, Community Based | 15417 Pinehurst Dr., Basehor, KS 66012 | 2007-06-07 |
| 1427137702 | Jacqueline Liana Puno | Physical Therapist | 13035 Kansas Ave, Bonner Springs, KS 66012 | 2006-11-06 |
| 1679616973 | Geraldine Lee Heckart | Social Worker | 134 N 130th St, #c Sunny Days Clinical Services, Bonner Springs, KS 66012 | 2007-02-15 |
| 1942341565 | City of Bonner Springs | Ambulance | 205 E 2nd St, Bonner Springs, KS 66012-1001 | 2007-02-08 |
| 1649319864 | Gregory Karl Gomer | Chiropractor | 216 E 2nd St, Bonner Springs, KS 66012-1002 | 2007-02-05 |
| 1154656148 | Blum Family Dentistry, L.L.C. | Dentist | 216 E 2nd St, Bonner Springs, KS 66012-1002 | 2009-10-08 |
| 1326325739 | Nitschke Eye Care, P.a. | Optometrist | 116 Cedar St, Bonner Springs, KS 66012-1016 | 2011-11-14 |
| 1457446437 | Degolers Inc | Pharmacy | 202 Oak St, Bonner Springs, KS 66012-1029 | 2006-10-04 |
| 1912043480 | Living Concepts, Inc. | Home Health | 402 E 2nd St, Bonner Springs, KS 66012-1039 | 2007-01-30 |
| Find all providers in zip 66012 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003437419 | Lewis H. Roht | General Practice | 12512 High Drive, Leawood, KS 66209-1341 | 2020-04-27 |
| 1437794302 | Sme Kansas P.a. | General Practice | 7300 West 110th Street, Commerce Plaza 1 7th Floor, Overland Park, KS 66210 | 2019-11-14 |
| 1508360405 | Landmark Medical of Kansas Pa | General Practice | 5350 College Blvd Ste 122, Overland Park, KS 66211-1633 | 2018-03-23 |
| 1902342892 | Drsalliance LLC | General Practice | 13968 Santa Fe Trail Dr, Lenexa, KS 66215-3382 | 2017-01-16 |
| 1114470010 | St Catherine Hospital | General Practice | 2051 E Mary St, Garden City, KS 67846-3617 | 2016-07-27 |
| 1053706655 | Aubrey Shea Ralston | General Practice | 700 W Central Ave Ste 205, El Dorado, KS 67042 | 2015-03-31 |
| 1245631100 | James Berry | General Practice | 10821 S Whitetail Ln, Olathe, KS 66061-9395 | 2014-09-10 |
| 1427470087 | Chs Health Services, LLC | General Practice | 2000 Nw Us Highway 24, Topeka, KS 66618-1445 | 2014-01-15 |
| 1942556824 | Leland Ray Kaufman | General Practice | 1500 E. 10th, Bldg B/2, Winfield, KS 67156 | 2012-07-30 |
| 1417211665 | James M Stanford | General Practice | 202 S Frisco St, Coldwater, KS 67029-9101 | 2012-07-02 |
| Find all providers with the same taxonomy | ||||
| City | BONNER SPRINGS |
| Zip Code | 66012 |
Please comment or provide details below to improve the information on PROVIDENCE CARE AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.