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NPI Code Detail

MEDICARE: CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.

MEDICARE: CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.
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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1016144OTHERKSBLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710988134
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.
Provider Business Mailing Address
First Line : 1309 POLK ST
Second Line :
City : GREAT BEND
State : KS
Zip : 67530-3618
Country : US
Telephone Number : 620-793-5404
Fax Number : 620-792-2665
Provider Business Practice Location Address
First Line : 1309 POLK ST
Second Line :
City : GREAT BEND
State : KS
Zip : 67530-3618
Country : US
Telephone Number : 620-793-5404
Fax Number : 620-792-2665
Authorized Official
Title or Position : PRESIDENT
Name : PERRY M SMITH
Credential : M.D.
Telephone Number : 620-793-5404
Provider Enumeration Date : 08/09/2005
Last Update Date : 04/01/2013

Similar Medicare Providers

1124029392 — PERRY M SMITH M.D.
Practice Location Address:
1309 POLK ST
GREAT BEND, KS
67530-3618
Practice Phone: 620-792-5341
Practice Fax: 620-792-3702
1134120652 — JEFFREY E BROZEK M.D.
Practice Location Address:
1309 POLK ST
GREAT BEND, KS
67530-3618
Practice Phone: 620-792-5341
Practice Fax: 620-792-3702
1891796231 — TERI L TURKLE-HUSLIG M.D.
Practice Location Address:
1309 POLK ST
GREAT BEND, KS
67530-3618
Practice Phone: 620-792-5341
Practice Fax: 620-792-3702
1235130675 — CENTRAL KANSAS FAMILY PRACTICE, P.A.
Practice Location Address:
1309 POLK ST
GREAT BEND, KS
67530-3618
Practice Phone: 620-792-5341
Practice Fax: 620-792-3702
1952302226 — KATHLEEN A KOTTAS ARNP
Practice Location Address:
1309 POLK ST
GREAT BEND, KS
67530-3618
Practice Phone: 620-792-5341
Practice Fax: 620-792-3702
1962093328 — DR. AISLINN RHEA CASSELS-HYDE D.C.
Practice Location Address:
2146 NE 4TH ST STE 160
BEND, OR
97701-3618
Practice Phone: 541-306-4471
Practice Fax:

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