MEDICARE: KANSAS ORTHOPAEDIC CENTER, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	KS
2	335E00000X	Prosthetic/Orthotic Supplier	KS
3	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1578908299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS ORTHOPAEDIC CENTER, PA

Provider Business Mailing Address
First Line	:	7550 W VILLAGE CIR
Second Line	:	SUITE 1
City	:	WICHITA
State	:	KS
Zip	:	67205-9363
Country	:	US
Telephone Number	:	316-838-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 N WOODLAWN BLVD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-3902
Country	:	US
Telephone Number	:	316-838-2020
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LIZANN TOLBERD
Credential	:
Telephone Number	:	316-838-2020

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	12/16/2020

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