Provider Demographics
NPI:1033246459
Name:COTTON-ONEIL CLINIC ENDOSCOPY CENTER RVOC TR
Entity Type:Organization
Organization Name:COTTON-ONEIL CLINIC ENDOSCOPY CENTER RVOC TR
Other - Org Name:COTTON O'NEIL ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:785-354-9591
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:ATTN: CORP FINANCE
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-5620
Mailing Address - Fax:785-357-2878
Practice Address - Street 1:720 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606
Practice Address - Country:US
Practice Address - Phone:785-270-4884
Practice Address - Fax:785-270-4852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STORMONT VAIL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS112218OtherMEDICARE PTAN
KS200005760AMedicaid