Provider Demographics
NPI:1083864219
Name:RENOVO MEDICAL LLC
Entity Type:Organization
Organization Name:RENOVO MEDICAL LLC
Other - Org Name:UNIVERSITY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHYSICIAN ASSISTANT
Authorized Official - Prefix:PROF
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ERSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:SCD PA-C
Authorized Official - Phone:620-805-5162
Mailing Address - Street 1:816 N CAMPUS DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6329
Mailing Address - Country:US
Mailing Address - Phone:620-805-5162
Mailing Address - Fax:620-805-5183
Practice Address - Street 1:816 N CAMPUS DR
Practice Address - Street 2:SUITE 500
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6329
Practice Address - Country:US
Practice Address - Phone:620-805-5162
Practice Address - Fax:620-805-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416265202K00000X
KSKS0434389208D00000X, 208D00000X
KS1500265363AS0400X
KS45404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200063310FMedicaid
KS1669659967OtherNPI KRISTI L. SCHMITT
659930OtherFIRST GUARD
055515OtherBCBS
KS1730135500OtherNPI
KS1487634069OtherNPI JOEL T. ERSKIN PA-C
659930OtherFIRST GUARD
427169Medicare PIN
B68200Medicare UPIN
104092Medicare PIN
042556Medicare PIN