Healthcare Provider Details

I. General information

NPI: 1760261424
Provider Name (Legal Business Name): MR. ALEX OLBERDING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COMMERCIAL ST
EMPORIA KS
66801-2916
US

IV. Provider business mailing address

1054 S CYPRESS ST
WICHITA KS
67207-3613
US

V. Phone/Fax

Practice location:
  • Phone: 316-990-5158
  • Fax:
Mailing address:
  • Phone: 316-990-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: