Provider Demographics
NPI:1245521814
Name:JAYHAWK PRIMARY CARE INC
Entity type:Organization
Organization Name:JAYHAWK PRIMARY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:913-588-3506
Mailing Address - Street 1:7405 RENNER ROAD
Mailing Address - Street 2:KU MEDWEST THERAPY
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-0000
Mailing Address - Country:US
Mailing Address - Phone:913-588-3506
Mailing Address - Fax:913-588-3508
Practice Address - Street 1:7405 RENNER ROAD
Practice Address - Street 2:KU MEDWEST THERAPY
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-0000
Practice Address - Country:US
Practice Address - Phone:913-588-3506
Practice Address - Fax:913-588-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment