Provider Demographics
NPI:1992780621
Name:ALDIS, RICHARD G (RPA C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:ALDIS
Suffix:
Gender:M
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W. 13TH
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1401
Mailing Address - Country:US
Mailing Address - Phone:620-896-7324
Mailing Address - Fax:620-896-7186
Practice Address - Street 1:700 W. 13TH
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1401
Practice Address - Country:US
Practice Address - Phone:620-896-7306
Practice Address - Fax:620-896-2084
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1992780621OtherNPI
KS426966OtherMEDICARE ATTICA
KS100388280AMedicaid
KS427150OtherMEDICARE HARPER
KS100388280AMedicaid