Healthcare Provider Details

I. General information

NPI: 1609813005
Provider Name (Legal Business Name): ORTHOKANSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 6TH ST SUITE 124
LAWRENCE KS
66044-2215
US

IV. Provider business mailing address

1112 W 6TH ST SUITE 124
LAWRENCE KS
66044-2215
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-9125
  • Fax: 785-843-3176
Mailing address:
  • Phone: 785-843-9125
  • Fax: 785-843-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE SWAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-838-7848