Provider Demographics
NPI:1720041445
Name:CENTRAL KANSAS SURGICAL SERVICES P.A.
Entity type:Organization
Organization Name:CENTRAL KANSAS SURGICAL SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-653-4191
Mailing Address - Street 1:351 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1715
Mailing Address - Country:US
Mailing Address - Phone:620-653-4191
Mailing Address - Fax:620-653-4566
Practice Address - Street 1:351 W 10TH ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1715
Practice Address - Country:US
Practice Address - Phone:620-653-4191
Practice Address - Fax:620-653-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS061851Medicare ID - Type Unspecified