=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710282223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZINKOVSKY PEDIATRICS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2011
-----------------------------------------------------
Last Update Date | 01/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3730 N RIDGE RD SUITE 100
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67205-1227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-462-6200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 N ASHLEY PARK
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67212-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-773-6588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SOPHIA M ZINKOVSKY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 316-773-6588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 04-28830
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------