Healthcare Provider Details

I. General information

NPI: 1497617286
Provider Name (Legal Business Name): CENTRAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W CENTRAL AVE
EL DORADO KS
67042-2112
US

IV. Provider business mailing address

PO BOX 256
SALINA KS
67402-0256
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-8780
  • Fax:
Mailing address:
  • Phone: 785-823-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE EVANS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 620-603-8846