MEDICARE: WESTERN KANSAS SURGICAL PROFESSIONAL ASSOCIATION

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

General Provider Information

NPI Number	:	1437169778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN KANSAS SURGICAL PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	311 E SPRUCE ST
Second Line	:	SUITE 2-A
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5684
Country	:	US
Telephone Number	:	620-275-3740
Fax Number	:	620-275-3020

Provider Business Practice Location Address
First Line	:	311 E SPRUCE ST
Second Line	:	SUITE 2-A
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5684
Country	:	US
Telephone Number	:	620-275-3740
Fax Number	:	620-275-3020

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALFREDO F GURMENDI
Credential	:	M.D.
Telephone Number	:	620-275-3740

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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