=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518968866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLINT HILLS SURGICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2522 W 15TH AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-6102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-343-7043
-----------------------------------------------------
Fax | 620-343-8571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2522 W 15TH AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-6102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-343-7043
-----------------------------------------------------
Fax | 620-343-8571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH EDWARD BOSILJEVAC JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 620-343-7043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------