Healthcare Provider Details

I. General information

NPI: 1467825679
Provider Name (Legal Business Name): KANSAS MEDICAL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SW WANAMAKER DR
TOPEKA KS
66614-5328
US

IV. Provider business mailing address

2200 SW 6TH AVE SUITE 104
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-6860
  • Fax: 785-272-5839
Mailing address:
  • Phone: 785-354-8518
  • Fax: 785-354-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: AMBER KENNEDY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 785-295-0936