Basic Information
| Provider Information | |||||||||
| NPI: | 1053784496 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERIDAN EMERGENCY PHYSICIAN SERVICES OF KANSAS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 453548 | ||||||||
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| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333453548 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135964862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2015 | ||||||||
| LastUpdateDate: | 11/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | ANDRULONIS | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.