Basic Information
| Provider Information | |||||||||
| NPI: | 1063704401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY AND SLEEP CONSULTANTS OF KANSAS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N. CYPRESS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672264003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401010 | ||||||||
| FaxNumber: | 3164400802 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N. CYPRESS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672264003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401010 | ||||||||
| FaxNumber: | 3164400802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | HINER | ||||||||
| AuthorizedOfficialFirstName: | MANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3164401010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 200328110A | 01 | OK | MEDICAID | OTHER | 200717670A | 05 | KS | MEDICAID |