Healthcare Provider Details

I. General information

NPI: 1124094867
Provider Name (Legal Business Name): ADVANCED DERMATOLOGY AND SKIN CANCER CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 PEMBROOK PL
MANHATTAN KS
66502-7482
US

IV. Provider business mailing address

2735 PEMBROOK PLACE
MANHATTAN KS
66502
US

V. Phone/Fax

Practice location:
  • Phone: 785-537-4990
  • Fax: 785-537-1938
Mailing address:
  • Phone: 785-537-4990
  • Fax: 785-537-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN R ADAMS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 785-537-4990