Provider Demographics
NPI:1265479059
Name:KANSAS JOINT & SPINE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:KANSAS JOINT & SPINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-219-8299
Mailing Address - Street 1:10100 E SHANNON WOODS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4104
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:10100 E SHANNON WOODS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4104
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:316-219-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100446460AMedicaid
KS110848OtherBLUE SHIELD
4684200001OtherDMERC
4684200001OtherDMERC
4684200001Medicare NSC