Healthcare Provider Details

I. General information

NPI: 1124563093
Provider Name (Legal Business Name): TALLGRASS ORTHOPEDIC AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 SW MISSION VIEW DR SUITE 200
TOPEKA KS
66614-5652
US

IV. Provider business mailing address

6001 SW 6TH AVE SUITE 200
TOPEKA KS
66615-1011
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-7491
  • Fax: 785-233-3187
Mailing address:
  • Phone: 785-233-7491
  • Fax: 785-233-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA BARNWELL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 785-295-4501