Basic Information
| Provider Information | |||||||||
| NPI: | 1477979417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-KANSAS PM&R LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 267 | ||||||||
| Address2: | |||||||||
| City: | BENTLEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670160267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166408026 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 E 23RD AVE | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205134100 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2014 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | O'BRIEN-LEIGHTON | ||||||||
| AuthorizedOfficialFirstName: | ROBBIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3166408027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 0432482 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.