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General NPI Number Information
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NPI Number | 1952158297
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Entity Type | Organization
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Legal Business Name | INTEGRATED DIGESTIVE PARTNERS OF KS, P.A.
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Dates
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Enumeration Date | 05/03/2024
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 1100 SW WANAMAKER RD STE 103
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City | TOPEKA
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State | KS
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Zip | 66604-3805
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Country | US
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Telephone | 646-876-8455
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Fax | 833-314-0246
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Provider Business Mailing Address
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Address Line | 228 PARK AVE S STE 16389
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City | NEW YORK
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State | NY
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Zip | 10003-1502
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Country | US
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Telephone | 646-876-8455
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Fax | 833-314-0246
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Authorized Official
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Title or Position | LICENSING AND CREDENTIALING MANAGER
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Name | JEFFREY KOO
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Credential |
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Telephone | 646-876-8455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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