1033246459 NPI number — COTTON-ONEIL CLINIC ENDOSCOPY CENTER RVOC TR

Table of content: (NPI 1033246459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033246459 NPI number — COTTON-ONEIL CLINIC ENDOSCOPY CENTER RVOC TR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COTTON-ONEIL CLINIC ENDOSCOPY CENTER RVOC TR
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:
6
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:
1033246459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SW 10TH AVE
Provider Second Line Business Mailing Address:
ATTN: CORP FINANCE
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-354-5620
Provider Business Mailing Address Fax Number:
785-357-2878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 SW LANE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-270-4884
Provider Business Practice Location Address Fax Number:
785-270-4852
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOCUM
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
785-354-9591

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112218 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200005760A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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