Provider Demographics
NPI:1053851261
Name:PROMEDT
Entity Type:Organization
Organization Name:PROMEDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-408-5228
Mailing Address - Street 1:6021 SW 29TH ST
Mailing Address - Street 2:SUITE 1 PMB 358
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6200
Mailing Address - Country:US
Mailing Address - Phone:785-408-5228
Mailing Address - Fax:785-783-8026
Practice Address - Street 1:1125 SW GAGE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2280
Practice Address - Country:US
Practice Address - Phone:785-783-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care