MEDICARE: PS127&JN434, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1134420821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PS127&JN434, LLC

Provider Business Mailing Address
First Line	:	6021 SW 29TH ST STE A
Second Line	:	PMB 358
City	:	TOPEKA
State	:	KS
Zip	:	66614-6201
Country	:	US
Telephone Number	:	785-408-5228
Fax Number	:	785-783-8026

Provider Business Practice Location Address
First Line	:	2655 SW WANAMAKER RD STE H
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-4477
Country	:	US
Telephone Number	:	785-408-5228
Fax Number	:	785-783-8026

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JOSHUA HESTON
Credential	:
Telephone Number	:	785-408-5228

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	09/28/2020

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