Provider Demographics
NPI:1386613107
Name:SURGICAL SPECIALISTS PA
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-945-7309
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0905
Mailing Address - Country:US
Mailing Address - Phone:316-945-7309
Mailing Address - Fax:316-945-9131
Practice Address - Street 1:4013 N RIDGE RD
Practice Address - Street 2:STE 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8860
Practice Address - Country:US
Practice Address - Phone:316-945-7309
Practice Address - Fax:316-945-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217610AMedicaid
KS110234Medicare ID - Type Unspecified