Basic Information
| Provider Information | |||||||||
| NPI: | 1902395262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOPEKA PHYSICIAN GROUP, LLC | ||||||||
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| OtherOrganizationName: | THE UNIVERSITY OF KANSAS PHYSICIANS TOPEKA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BURTON HILLS BLVD STE 250 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152963000 | ||||||||
| FaxNumber: | 6152966227 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | VALLEY FALLS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7859453263 | ||||||||
| FaxNumber: | 7859453902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2018 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | PETROVICH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP | ||||||||
| AuthorizedOfficialTelephone: | 6152963000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TOPEKA HEALTH SYSTEM, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.