Healthcare Provider Details

I. General information

NPI: 1790589398
Provider Name (Legal Business Name): PATRIOTMED OF KANSAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 GARDEN WAY
MANHATTAN KS
66502-1786
US

IV. Provider business mailing address

1132 GARDEN WAY
MANHATTAN KS
66502-1786
US

V. Phone/Fax

Practice location:
  • Phone: 480-369-1270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT THORNOCK
Title or Position: CHIEF STRATEGY OFFICER
Credential:
Phone: 480-369-1270