Basic Information
| Provider Information | |||||||||
| NPI: | 1326082959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POHORECKI | ||||||||
| FirstName: | ROMAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 739 | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679050739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206241550 | ||||||||
| FaxNumber: | 6206242545 | ||||||||
| Practice Location | |||||||||
| Address1: | 15TH AT PERSHING | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679012455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206241651 | ||||||||
| FaxNumber: | 6206296655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 04-27483 | KS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 101423 | 01 | KS | BLUE CROSS | OTHER |