Healthcare Provider Details

I. General information

NPI: 1225168206
Provider Name (Legal Business Name): INCONTINENCE AND OSTEOPOROSIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 FOUR STATES DR SUITE 1
GALENA KS
66739-4304
US

IV. Provider business mailing address

198 FOUR STATES DR STE 1
GALENA KS
66739-4305
US

V. Phone/Fax

Practice location:
  • Phone: 620-783-2356
  • Fax: 620-783-2395
Mailing address:
  • Phone: 620-783-2356
  • Fax: 620-783-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number106994
License Number StateMO

VIII. Authorized Official

Name: DR. CHRISTOPHER ROBERTS
Title or Position: OWNER
Credential: MD
Phone: 620-783-2356