1144248899 NPI number — SANDHILL ORTHOPAEDIC & SPORTSMEDICINE, LLC

Table of content: (NPI 1144248899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144248899 NPI number — SANDHILL ORTHOPAEDIC & SPORTSMEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILL ORTHOPAEDIC & SPORTSMEDICINE, LLC
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144248899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E FULTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67846-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-275-8400
Provider Business Mailing Address Fax Number:
620-275-2687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E FULTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-275-8400
Provider Business Practice Location Address Fax Number:
620-275-2687
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NUSSER
Authorized Official First Name:
HALLIE
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
BUSINESSOFFICE MANAGER
Authorized Official Telephone Number:
620-275-8400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  04-21693 , 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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