Healthcare Provider Details

I. General information

NPI: 1578772786
Provider Name (Legal Business Name): PEASE & SMITH, MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 E 23RD AVE
HUTCHINSON KS
67502-1114
US

IV. Provider business mailing address

1712 E 23RD AVE
HUTCHINSON KS
67502-1114
US

V. Phone/Fax

Practice location:
  • Phone: 620-662-4458
  • Fax:
Mailing address:
  • Phone: 620-662-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOLEEN K SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 620-662-4458