Healthcare Provider Details

I. General information

NPI: 1174502272
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF TOPEKA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW 6TH AVE SUITE 103
TOPEKA KS
66606-1707
US

IV. Provider business mailing address

2200 SW 6TH AVE SUITE 103
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-1254
  • Fax: 785-354-1598
Mailing address:
  • Phone: 785-354-1254
  • Fax: 785-354-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberS-089-004
License Number StateKS

VIII. Authorized Official

Name: PHILLIP A CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283