Healthcare Provider Details

I. General information

NPI: 1851953244
Provider Name (Legal Business Name): KANSAS TALENT CLUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 SE 27TH ST
TOPEKA KS
66605-1413
US

IV. Provider business mailing address

PO BOX 1721
TOPEKA KS
66601-1721
US

V. Phone/Fax

Practice location:
  • Phone: 785-438-7592
  • Fax:
Mailing address:
  • Phone: 785-438-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: TINENE BEAVER
Title or Position: NON MEDICAL TRANSPORTATION PROVIDER
Credential:
Phone: 785-438-7592