MEDICARE: THE PLASTIC SURGERY CLINIC PA

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	2086S0105X	Surgery of the Hand (Surgery) Physician	04-23013	KS
2	208200000X	Plastic Surgery Physician	04-28013	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110967	OTHER	KS	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1841486313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PLASTIC SURGERY CLINIC PA

Provider Business Mailing Address
First Line	:	1419 WESTPORT LANDING PL
Second Line	:	SUITE 101
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2906
Country	:	US
Telephone Number	:	785-776-7500
Fax Number	:	785-770-8558

Provider Business Practice Location Address
First Line	:	1419 WESTPORT LANDING PL
Second Line	:	SUITE 101
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2906
Country	:	US
Telephone Number	:	785-776-7500
Fax Number	:	785-770-8558

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. KENNETH ALLEN FISCHER
Credential	:	M.D.
Telephone Number	:	785-776-7500

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	10/30/2012

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Directions to “THE PLASTIC SURGERY CLINIC PA ” Practice Location

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