MEDICARE: INTEGRATED DIGESTIVE PARTNERS OF KS, P.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	1041C0700X	Clinical Social Worker
3	133V00000X	Registered Dietitian
4	207RG0100X	Gastroenterology Physician
5	363A00000X	Physician Assistant
6	103T00000X	Psychologist
7	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1952158297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED DIGESTIVE PARTNERS OF KS, P.A.

Provider Business Mailing Address
First Line	:	228 PARK AVE S STE 16389
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-876-8455
Fax Number	:	833-314-0246

Provider Business Practice Location Address
First Line	:	1100 SW WANAMAKER RD STE 103
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66604-3805
Country	:	US
Telephone Number	:	646-876-8455
Fax Number	:	833-314-0246

Authorized Official
Title or Position	:	LICENSING AND CREDENTIALING MANAGER
Name	:	JEFFREY KOO
Credential	:
Telephone Number	:	646-876-8455

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	07/16/2024

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Directions to “INTEGRATED DIGESTIVE PARTNERS OF KS, P.A. ” Practice Location

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