Healthcare Provider Details

I. General information

NPI: 1184008856
Provider Name (Legal Business Name): FLINT HILLS DIALYSIS OF JUNCTION CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SAINT MARYS RD STE 101
JUNCTION CITY KS
66441-4176
US

IV. Provider business mailing address

1133 COLLEGE AVE B100
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-565-9500
  • Fax: 785-565-9595
Mailing address:
  • Phone: 785-565-9500
  • Fax: 785-565-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. IMAD BEDROS
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-565-9500