Provider Demographics
NPI:1225168206
Name:INCONTINENCE AND OSTEOPOROSIS CENTER LLC
Entity Type:Organization
Organization Name:INCONTINENCE AND OSTEOPOROSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-783-2356
Mailing Address - Street 1:198 FOUR STATES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4305
Mailing Address - Country:US
Mailing Address - Phone:620-783-2356
Mailing Address - Fax:620-783-2395
Practice Address - Street 1:198 FOUR STATES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4304
Practice Address - Country:US
Practice Address - Phone:620-783-2356
Practice Address - Fax:620-783-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106994207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3311Medicare PIN
KSKA2171Medicare PIN