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General NPI Number Information
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NPI Number | 1720345911
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Entity Type | Organization
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Legal Business Name | KANSAS SPINE ANESTHESIA CORPORATION PA
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 3333 N WEBB RD
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City | WICHITA
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State | KS
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Zip | 67226-8123
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Country | US
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Telephone | 316-462-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3547
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City | WICHITA
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State | KS
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Zip | 67201-3547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHANDRA TOKALA
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Credential | MD
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Telephone | 316-462-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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