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General NPI Number Information
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NPI Number | 1205862984
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Entity Type | Organization
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Legal Business Name | ENDOSCOPIC SERVICES, P.A.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 1431 BLUFFVIEW ST STE 215
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City | WICHITA
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State | KS
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Zip | 67218-3039
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Country | US
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Telephone | 316-687-0234
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Fax | 316-687-0360
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Provider Business Mailing Address
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Address Line | 1431 BLUFFVIEW ST STE 215
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City | WICHITA
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State | KS
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Zip | 67218-3039
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Country | US
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Telephone | 316-687-0234
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Fax | 316-687-0360
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Authorized Official
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Title or Position | CEO
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Name | MR. JACE WARD HYDER
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Credential | M.D.
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Telephone | 316-687-0234
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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 | S-087-008
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License Number State | KS
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