Provider Demographics
NPI:1215903976
Name:KANSAS SURGICAL CONSULTANTS, LLP
Entity type:Organization
Organization Name:KANSAS SURGICAL CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-685-6222
Mailing Address - Street 1:3243 E MURDOCK ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3052
Mailing Address - Country:US
Mailing Address - Phone:316-685-6222
Mailing Address - Fax:316-685-1273
Practice Address - Street 1:3243 E MURDOCK ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3052
Practice Address - Country:US
Practice Address - Phone:316-685-6222
Practice Address - Fax:316-685-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100304460AMedicaid
KS100304460AMedicaid