Provider Demographics
NPI:1184008856
Name:FLINT HILLS DIALYSIS OF JUNCTION CITY
Entity Type:Organization
Organization Name:FLINT HILLS DIALYSIS OF JUNCTION CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-565-9500
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:B100
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-565-9500
Mailing Address - Fax:785-565-9595
Practice Address - Street 1:1110 SAINT MARYS RD
Practice Address - Street 2:STE 101
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4176
Practice Address - Country:US
Practice Address - Phone:785-565-9500
Practice Address - Fax:785-565-9595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLINT HILLS DIALYSIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment