Provider Demographics
NPI:1114037322
Name:EMPORIA HEAD NECK P.A.
Entity Type:Organization
Organization Name:EMPORIA HEAD NECK P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:FORDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-343-3533
Mailing Address - Street 1:1130 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2549
Mailing Address - Country:US
Mailing Address - Phone:620-343-3533
Mailing Address - Fax:620-343-7239
Practice Address - Street 1:1130 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2549
Practice Address - Country:US
Practice Address - Phone:620-343-3533
Practice Address - Fax:620-343-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016540OtherBCBS
KS016450Medicare ID - Type Unspecified
KS016540OtherBCBS