Healthcare Provider Details

I. General information

NPI: 1639096365
Provider Name (Legal Business Name): CHARLES VANHOUDEN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W MAIN ST
CHANUTE KS
66720-1607
US

IV. Provider business mailing address

4631 S COUNTRY CLUB RD
CHANUTE KS
66720-5198
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-7193
  • Fax: 620-431-7741
Mailing address:
  • Phone: 620-431-7193
  • Fax: 620-431-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES VANHOUDEN
Title or Position: OWNER
Credential: MD
Phone: 620-433-0609