Basic Information
| Provider Information | |||||||||
| NPI: | 1215903976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS SURGICAL CONSULTANTS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3243 E MURDOCK ST | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166856222 | ||||||||
| FaxNumber: | 3166851273 | ||||||||
| Practice Location | |||||||||
| Address1: | 3243 E MURDOCK ST | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166856222 | ||||||||
| FaxNumber: | 3166851273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | DEBBRECHT | ||||||||
| AuthorizedOfficialFirstName: | MICKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3166856222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100304460A | 05 | KS | MEDICAID |