Healthcare Provider Details

I. General information

NPI: 1508877523
Provider Name (Legal Business Name): KANSAS MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW 6TH AVE
TOPEKA KS
66606-1707
US

IV. Provider business mailing address

PO BOX 255
MANHATTAN KS
66505-0255
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-8518
  • Fax: 785-354-1255
Mailing address:
  • Phone: 785-232-2284
  • Fax: 785-232-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE MEIER
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-295-0956