Provider Demographics
NPI:1558347104
Name:TALLGRASS PRAIRIE SURGICAL SPECIALIST PA
Entity type:Organization
Organization Name:TALLGRASS PRAIRIE SURGICAL SPECIALIST PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-295-4536
Mailing Address - Street 1:6001 SW 6TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1011
Mailing Address - Country:US
Mailing Address - Phone:785-233-7491
Mailing Address - Fax:785-233-3187
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:785-233-7491
Practice Address - Fax:785-233-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty