Healthcare Provider Details

I. General information

NPI: 1659640134
Provider Name (Legal Business Name): FLINT HILLS DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N 18TH ST SOUTH PLAZA
MARYSVILLE KS
66508-1338
US

IV. Provider business mailing address

1133 COLLEGE AVE BUILDING B, SUITE 266
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-565-9500
  • Fax: 785-565-9595
Mailing address:
  • Phone: 785-565-9500
  • Fax: 785-565-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: DR. FADI V BEDROS
Title or Position: OWNER
Credential: MD
Phone: 785-565-9500