MEDICARE: TALLGRASS PRAIRIE SURGICAL SPECIALIST PA

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1558347104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLGRASS PRAIRIE SURGICAL SPECIALIST PA

Provider Business Mailing Address
First Line	:	6001 SW 6TH AVE
Second Line	:	SUITE 200
City	:	TOPEKA
State	:	KS
Zip	:	66615-1011
Country	:	US
Telephone Number	:	785-233-7491
Fax Number	:	785-233-3187

Provider Business Practice Location Address
First Line	:	6001 SW 6TH AVE
Second Line	:	SUITE 200
City	:	TOPEKA
State	:	KS
Zip	:	66615-1011
Country	:	US
Telephone Number	:	785-233-7491
Fax Number	:	785-233-3187

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. DOUG BOWEN
Credential	:
Telephone Number	:	785-295-4536

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/22/2020

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