Provider Demographics
NPI:1407183494
Name:OSWALDO C BACANI MD CHARTERED
Entity type:Organization
Organization Name:OSWALDO C BACANI MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSWALDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BACANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-378-3700
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-0576
Mailing Address - Country:US
Mailing Address - Phone:620-378-3700
Mailing Address - Fax:620-378-3536
Practice Address - Street 1:1525 MADISON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1703
Practice Address - Country:US
Practice Address - Phone:620-378-3700
Practice Address - Fax:620-378-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417538208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty