Provider Demographics
NPI:1174274567
Name:KANSAS COVID RESPONSE LLC
Entity Type:Organization
Organization Name:KANSAS COVID RESPONSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-771-7315
Mailing Address - Street 1:8335 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1839
Mailing Address - Country:US
Mailing Address - Phone:316-771-7315
Mailing Address - Fax:316-771-7319
Practice Address - Street 1:8335 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1839
Practice Address - Country:US
Practice Address - Phone:316-771-7315
Practice Address - Fax:316-771-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory