Provider Demographics
NPI:1215314380
Name:POTTER PLASTIC & RECONSTRUCTIVE SURGERY, PA
Entity type:Organization
Organization Name:POTTER PLASTIC & RECONSTRUCTIVE SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-639-1668
Mailing Address - Street 1:217 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1698
Mailing Address - Country:US
Mailing Address - Phone:785-301-2250
Mailing Address - Fax:785-301-2270
Practice Address - Street 1:217 E 32ND ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1698
Practice Address - Country:US
Practice Address - Phone:785-301-2250
Practice Address - Fax:785-301-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-33528207KA0200X, 208600000X, 2086S0122X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty