Basic Information
| Provider Information | |||||||||
| NPI: | 1265869127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TALLGRASS ANESTHESIOLOGY ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 47662 | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672017662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004756236 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6001 SW 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666151011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858620339 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2013 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | WETZEL | ||||||||
| AuthorizedOfficialFirstName: | ORVILLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7858620339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.