Healthcare Provider Details

I. General information

NPI: 1417870726
Provider Name (Legal Business Name): BEN ANDREW BROXTERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

410 EHLERS RD
MANHATTAN KS
66502-4533
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number6803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: