MEDICARE: HIGH PLAINS UROLOGY 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	174400000X	Specialist	04-31290	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	22D1014554	OTHER	KS	CLIA

General Provider Information

NPI Number	:	1922139401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH PLAINS UROLOGY LLC

Provider Business Mailing Address
First Line	:	311 E SPRUCE ST
Second Line	:	SUITE 3A
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5684
Country	:	US
Telephone Number	:	620-275-3760
Fax Number	:	620-275-3057

Provider Business Practice Location Address
First Line	:	311 E SPRUCE ST
Second Line	:	SUITE 3A
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5684
Country	:	US
Telephone Number	:	620-275-3760
Fax Number	:	620-275-3057

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BEVERLY CATANESE
Credential	:	RN
Telephone Number	:	620-275-3008

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	03/07/2023

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Directions to “HIGH PLAINS UROLOGY LLC ” Practice Location

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