Provider Demographics
NPI:1235114554
Name:TALLGRASS ANESTHESIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:TALLGRASS ANESTHESIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-685-3698
Mailing Address - Street 1:PO BOX 47662
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7662
Mailing Address - Country:US
Mailing Address - Phone:316-685-3698
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:316-685-3698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCK4332OtherRAILROAD MEDICARE
KS110803OtherBCBS OF KANSAS
KS=========OtherTRICARE
KS110803Medicare ID - Type Unspecified