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General NPI Number Information
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NPI Number | 1356012181
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Entity Type | Organization
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Legal Business Name | ADDICTION TOXICOLOGY OF KANSAS LLC
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 3600 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67218-3713
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Country | US
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Telephone | 316-268-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 E KALISPELL CT
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City | ANDOVER
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State | KS
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Zip | 67002-7982
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Country | US
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Telephone | 252-864-5790
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY M R HAYNES
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Credential | MD
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Telephone | 252-864-5790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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