Healthcare Provider Details

I. General information

NPI: 1871592550
Provider Name (Legal Business Name): JOSHUA BLAINE PITTS CPO, FAAOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22215 TUPPER STREET SUITE B
WINFIELD KS
67156-1163
US

IV. Provider business mailing address

P.O. 1163 22215 TUPPER STREET, SUITE B
WINFIELD KS
67156-1163
US

V. Phone/Fax

Practice location:
  • Phone: 620-402-6789
  • Fax: 620-402-6791
Mailing address:
  • Phone: 620-402-6789
  • Fax: 620-402-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: