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General NPI Number Information
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NPI Number | 1386613107
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS PA
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 4013 N RIDGE RD STE 210
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City | WICHITA
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State | KS
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Zip | 67205-8860
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Country | US
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Telephone | 316-945-7309
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Fax | 316-945-9131
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Provider Business Mailing Address
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Address Line | PO BOX 905
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City | WICHITA
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State | KS
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Zip | 67201-0905
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Country | US
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Telephone | 316-945-7309
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Fax | 316-945-9131
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. JOHN P SMITH
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Credential | DO
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Telephone | 316-945-7309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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