Healthcare Provider Details

I. General information

NPI: 1699722900
Provider Name (Legal Business Name): TALLGRASS GENERAL, VASCULAR & THORACIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 SW 6TH AVE SUITE 220
TOPEKA KS
66615-1011
US

IV. Provider business mailing address

6001 SW 6TH AVE SUITE 220
TOPEKA KS
66615-1011
US

V. Phone/Fax

Practice location:
  • Phone: 785-232-0444
  • Fax: 785-232-1562
Mailing address:
  • Phone: 785-232-0444
  • Fax: 785-232-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULA VANDERWIEDE
Title or Position: OFFICE MANAGER
Credential:
Phone: 785-232-0444