Healthcare Provider Details

I. General information

NPI: 1801183108
Provider Name (Legal Business Name): OLSON MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MAIN STREET
PARSONS KS
67357-2727
US

IV. Provider business mailing address

2515 MAIN ST
PARSONS KS
67357-2727
US

V. Phone/Fax

Practice location:
  • Phone: 620-421-2727
  • Fax: 620-421-2744
Mailing address:
  • Phone: 620-421-2727
  • Fax: 620-421-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier358751
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: DAVID OLSON
Title or Position: OWNER
Credential:
Phone: 620-421-2727