Basic Information
| Provider Information | |||||||||
| NPI: | 1225446461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CENTER OF KANSAS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 N EMPORIA ST STE 403 | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3166134262 | ||||||||
| Practice Location | |||||||||
| Address1: | 737 E CRAWFORD ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674015103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3166134262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 09/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | ABRAHAM | ||||||||
| AuthorizedOfficialFirstName: | YOOSAF | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3166134256 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 110217 | 01 | MEDICARE PTAN | OTHER | 100217690A | 05 | KS | MEDICAID |