Provider Demographics
NPI:1588975007
Name:IMMEDIATE CARE AT TALLGRASS
Entity type:Organization
Organization Name:IMMEDIATE CARE AT TALLGRASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-234-2400
Mailing Address - Street 1:601 SW CORPORATE VIEW
Mailing Address - Street 2:STE. 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615
Mailing Address - Country:US
Mailing Address - Phone:785-234-2400
Mailing Address - Fax:785-271-2220
Practice Address - Street 1:601 SW CORPORATE VIEW
Practice Address - Street 2:STE. 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615
Practice Address - Country:US
Practice Address - Phone:785-234-2400
Practice Address - Fax:785-271-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75132-092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12116839OtherCAQH