MEDICARE: SAMBHUNDH PANICHABHONGSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	16833	KS
2	207Q00000X	Family Medicine Physician	16833	KS
3	207Q00000X	Family Medicine Physician	04-16833	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417943176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMBHUNDH PANICHABHONGSE MD

Provider Business Mailing Address
First Line	:	222 S. KANSAS
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665
Country	:	US
Telephone Number	:	785-483-3333
Fax Number	:	785-483-0781

Provider Business Practice Location Address
First Line	:	222 S KANSAS
Second Line	:	RRH PHYSICIANS CLINIC STE B
City	:	RUSSELL
State	:	KS
Zip	:	67665
Country	:	US
Telephone Number	:	785-483-3333
Fax Number	:	785-483-0781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	09/16/2010

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