Healthcare Provider Details

I. General information

NPI: 1952369001
Provider Name (Legal Business Name): LINCOLN CENTER OBGYN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SW LINCOLN ST
TOPEKA KS
66606-1515
US

IV. Provider business mailing address

800 SW LINCOLN ST
TOPEKA KS
66606-1515
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-5101
  • Fax: 785-233-1404
Mailing address:
  • Phone: 785-233-5101
  • Fax: 785-233-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS S GLEASON
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 785-233-5101