Basic Information
| Provider Information | |||||||||
| NPI: | 1841251394 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CENTER OF KANSAS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27005 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662255227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3162620706 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 N EMPORIA ST | ||||||||
| Address2: | STE 403 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3162620706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 06/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | DEUTSCH | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3166134257 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100217690A | 05 | KS | MEDICAID |