Healthcare Provider Details

I. General information

NPI: 1922425099
Provider Name (Legal Business Name): KANSAS ORTHOPAEDIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FULTON ST
GARDEN CITY KS
67846-5455
US

IV. Provider business mailing address

7550 W VILLAGE CIR
WICHITA KS
67205-9363
US

V. Phone/Fax

Practice location:
  • Phone: 316-838-2020
  • Fax: 316-838-7574
Mailing address:
  • Phone: 316-838-2020
  • Fax: 316-838-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LIZ ANN TOLBERD
Title or Position: ADMINISTRATOR
Credential:
Phone: 316-838-2020