Basic Information
| Provider Information | |||||||||
| NPI: | 1851327043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASS | ||||||||
| FirstName: | VELLO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8035 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672080035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166899135 | ||||||||
| FaxNumber: | 3166899102 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671148778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162845160 | ||||||||
| FaxNumber: | 3162845115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 25602 | KS | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100175470C | 05 | KS | MEDICAID | 5093 | 01 | KS | PHS | OTHER | 12149439 | 01 | KS | MULTIPLAN | OTHER | 201546 | 01 | KS | HPK | OTHER | 102033 | 01 | KS | BCBS | OTHER | 123898 | 01 | KS | COVENTRY | OTHER |