Healthcare Provider Details

I. General information

NPI: 1104062199
Provider Name (Legal Business Name): NEW CENTURY ORTHOPEDIC & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PINE ST
PITTSBURG KS
66762-4744
US

IV. Provider business mailing address

PO BOX 1539
PITTSBURG KS
66762-1539
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-5855
  • Fax:
Mailing address:
  • Phone: 620-231-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PATTERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-231-9072