Healthcare Provider Details

I. General information

NPI: 1720041445
Provider Name (Legal Business Name): CENTRAL KANSAS SURGICAL SERVICES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W 10TH ST
HOISINGTON KS
67544-1715
US

IV. Provider business mailing address

351 W 10TH ST
HOISINGTON KS
67544-1715
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-4191
  • Fax: 620-653-4566
Mailing address:
  • Phone: 620-653-4191
  • Fax: 620-653-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number05-25299
License Number StateKS

VIII. Authorized Official

Name: DR. ROBIN D DURRETT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 620-653-4191