Provider Demographics
NPI:1104062199
Name:NEW CENTURY ORTHOPEDIC & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:NEW CENTURY ORTHOPEDIC & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-9072
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1539
Mailing Address - Country:US
Mailing Address - Phone:620-231-3750
Mailing Address - Fax:
Practice Address - Street 1:100 N PINE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-4744
Practice Address - Country:US
Practice Address - Phone:620-231-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2141Medicare PIN