Healthcare Provider Details

I. General information

NPI: 1174560692
Provider Name (Legal Business Name): PHILLIP E. BORTMES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 COMMERCIAL ST
OSWEGO KS
67356-2312
US

IV. Provider business mailing address

PO BOX 736
PARSONS KS
67357-0736
US

V. Phone/Fax

Practice location:
  • Phone: 620-795-2340
  • Fax: 620-795-2341
Mailing address:
  • Phone: 620-820-5428
  • Fax: 620-820-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-19458
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: