Provider Demographics
NPI:1205862984
Name:ENDOSCOPIC SERVICES, P.A.
Entity Type:Organization
Organization Name:ENDOSCOPIC SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACE
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-687-0234
Mailing Address - Street 1:1431 BLUFFVIEW ST STE 215
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3039
Mailing Address - Country:US
Mailing Address - Phone:316-687-0234
Mailing Address - Fax:316-687-0360
Practice Address - Street 1:1431 BLUFFVIEW ST STE 215
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-687-0234
Practice Address - Fax:316-687-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS-087-008261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS015223OtherBCBS PROVIDER #
KS100216580AMedicaid