Provider Demographics
NPI:1164742565
Name:KANSAS JOINT & SPINE INSTITUTE
Entity Type:Organization
Organization Name:KANSAS JOINT & SPINE INSTITUTE
Other - Org Name:KANSAS JOINT AND SPINE PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK-BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-1900
Mailing Address - Street 1:10100 SHANNON WOODS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4103
Mailing Address - Country:US
Mailing Address - Phone:316-858-1900
Mailing Address - Fax:316-858-1905
Practice Address - Street 1:10100 SHANNON WOODS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4103
Practice Address - Country:US
Practice Address - Phone:316-858-1900
Practice Address - Fax:316-858-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2539OtherMEDICARE PTAN