Healthcare Provider Details

I. General information

NPI: 1831464635
Provider Name (Legal Business Name): THERAPEUTIC INJECTION SERVICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WAKARUSA DRIVE SUITE A2
LAWRENCE KS
66049-3889
US

IV. Provider business mailing address

PO BOX 388
NEWTON KS
67114-0388
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-8472
  • Fax:
Mailing address:
  • Phone: 316-281-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY GLASGOW
Title or Position: OWNER
Credential: CRNA
Phone: 785-856-8472