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General NPI Number Information
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NPI Number | 1164742565
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Entity Type | Organization
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Legal Business Name | KANSAS JOINT & SPINE INSTITUTE
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 10100 SHANNON WOODS ST
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City | WICHITA
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State | KS
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Zip | 67226-4103
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Country | US
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Telephone | 316-858-1900
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Fax | 316-858-1905
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Provider Business Mailing Address
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Address Line | 10100 SHANNON WOODS ST
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City | WICHITA
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State | KS
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Zip | 67226-4103
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Country | US
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Telephone | 316-858-1900
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Fax | 316-858-1905
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Authorized Official
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Title or Position | CEO
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Name | DEBBIE BROCK-BAKER
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Credential |
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Telephone | 316-858-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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