Basic Information
| Provider Information | |||||||||
| NPI: | 1437115029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLAZA MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1133 | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678461133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202768201 | ||||||||
| FaxNumber: | 6202750712 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202768201 | ||||||||
| FaxNumber: | 6202750712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | DENTON | ||||||||
| AuthorizedOfficialFirstName: | SHERI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6202768201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100088530B | 05 | KS | MEDICAID |