Provider Demographics
NPI:1043219843
Name:ADVANCED ORTHOPEDIC AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-225-7744
Mailing Address - Street 1:2300 N 14TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2368
Mailing Address - Country:US
Mailing Address - Phone:620-225-7744
Mailing Address - Fax:620-225-7002
Practice Address - Street 1:2300 N 14TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2368
Practice Address - Country:US
Practice Address - Phone:620-225-7744
Practice Address - Fax:620-225-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110806Medicare ID - Type Unspecified
KS4067630001Medicare NSC