1952532491 NPI number — JASON WILTSHIRE MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR

Table of content: (NPI 1952532491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952532491 NPI number — JASON WILTSHIRE MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASON WILTSHIRE MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1952532491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-0264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-825-6512
Provider Business Mailing Address Fax Number:
913-328-7011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8919 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-334-6800
Provider Business Practice Location Address Fax Number:
913-334-0875
Provider Enumeration Date:
07/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DORSEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO, PROVIDENCE HEALTH
Authorized Official Telephone Number:
913-596-4000

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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