Healthcare Provider Details

I. General information

NPI: 1538153887
Provider Name (Legal Business Name): KANSAS ENDOSCOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 N WEBB RD
WICHITA KS
67226-8119
US

IV. Provider business mailing address

3121 N WEBB RD
WICHITA KS
67226-8119
US

V. Phone/Fax

Practice location:
  • Phone: 316-261-3130
  • Fax: 316-261-3275
Mailing address:
  • Phone: 316-261-3130
  • Fax: 316-261-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberS087012
License Number StateKS

VIII. Authorized Official

Name: MRS. DEE NOLTING
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 316-261-3130