Provider Demographics
NPI:1023171634
Name:SHAWNEE MISSION MEDICAL CENTER INC
Entity type:Organization
Organization Name:SHAWNEE MISSION MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAIRILISE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTHIN OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-676-2153
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2000
Mailing Address - Fax:913-676-7571
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2000
Practice Address - Fax:913-676-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH046004282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
100017OtherFL HOSP HEALTH CARE SYSTE
KS100093850AMedicaid
MO011062106Medicaid
KS463869OtherCHILDREN'S MERCY FAMILY H
KS5020565OtherUHC
KS536816OtherHEALTHLINK
KS90003016OtherBLUE CROSS
KS536816OtherHEALTHLINK
KS=========OtherCOMMUNITY HEALTH
170104Medicare Oscar/Certification