Healthcare Provider Details

I. General information

NPI: 1770008849
Provider Name (Legal Business Name): TOPEKA PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SW 7TH ST
TOPEKA KS
66606-2489
US

IV. Provider business mailing address

1 BURTON HILLS BLVD STE 250
NASHVILLE TN
37215-6195
US

V. Phone/Fax

Practice location:
  • Phone: 785-295-8108
  • Fax: 785-231-5991
Mailing address:
  • Phone: 615-296-3000
  • Fax: 615-296-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C PETROVICH
Title or Position: EVP AND SECRETARY
Credential:
Phone: 615-296-3000