Basic Information
| Provider Information | |||||||||
| NPI: | 1780766865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STORMONT-VAIL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDICAL ARTS PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | CORPORATE FINANCE | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2252 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666043929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852358796 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | LANGLAND | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY/TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7853546167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 2-08850 | KS | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 100087720F | 05 | KS | MEDICAID |