1306827878 NPI number — KANSAS SURGERY & RECOVERY CENTER LLC

Table of content: (NPI 1306827878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306827878 NPI number — KANSAS SURGERY & RECOVERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANSAS SURGERY & RECOVERY CENTER 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:
1306827878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2770 N WEBB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67226-8112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-634-0090
Provider Business Mailing Address Fax Number:
316-634-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 N WEBB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-8112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-634-0090
Provider Business Practice Location Address Fax Number:
316-634-0005
Provider Enumeration Date:
11/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARTAL
Authorized Official First Name:
ELY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
316-630-4210

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H087008 , 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)

  • Identifier: 100289220A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001079 . This is a "BCBSKS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".