Healthcare Provider Details

I. General information

NPI: 1053388652
Provider Name (Legal Business Name): SOUTHEAST KANSAS PHYSICIAN ASSOCIATES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W 7TH ST
CHANUTE KS
66720-0943
US

IV. Provider business mailing address

PO BOX 943
CHANUTE KS
66720-0943
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-0340
  • Fax: 620-431-0434
Mailing address:
  • Phone: 620-431-0340
  • Fax: 620-431-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-20988
License Number StateKS

VIII. Authorized Official

Name: DR. CATHY M. TAYLOR
Title or Position: BUSINESS OWNER
Credential: M.D.
Phone: 620-431-0340