Healthcare Provider Details

I. General information

NPI: 1548813967
Provider Name (Legal Business Name): CLINICAL COLLEAGUES KS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 S PLUMMER AVE
CHANUTE KS
66720-1928
US

IV. Provider business mailing address

1765 E NINE MILE RD STE 1-229
PENSACOLA FL
32514-5479
US

V. Phone/Fax

Practice location:
  • Phone: 850-985-9180
  • Fax: 603-893-8886
Mailing address:
  • Phone: 850-985-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MARGARITE D GARNER
Title or Position: VP OPERATIONS, MEDICAL STAFF SERV
Credential:
Phone: 904-298-9590