Healthcare Provider Details

I. General information

NPI: 1285094102
Provider Name (Legal Business Name): PELVIC HEALTH SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 6TH ST STE 212
LAWRENCE KS
66044-2215
US

IV. Provider business mailing address

601 SW CORPORATE VW STE 200 ATTN: CREDENTIALING
TOPEKA KS
66615-1245
US

V. Phone/Fax

Practice location:
  • Phone: 785-727-7900
  • Fax: 785-727-7901
Mailing address:
  • Phone: 785-581-0670
  • Fax: 785-380-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number05-29352
License Number StateKS

VIII. Authorized Official

Name: CATHY L DAHL
Title or Position: OWNER
Credential: DO
Phone: 785-727-7900