Provider Demographics
NPI:1285094102
Name:PELVIC HEALTH SPECIALISTS, LLC
Entity type:Organization
Organization Name:PELVIC HEALTH SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-727-7900
Mailing Address - Street 1:601 SW CORPORATE VW STE 200
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1245
Mailing Address - Country:US
Mailing Address - Phone:785-581-0670
Mailing Address - Fax:785-380-4793
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:STE 212
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-727-7900
Practice Address - Fax:785-727-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-29352207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty