Provider Demographics
NPI:1265634315
Name:JOHN VRTISKA MD PA
Entity Type:Organization
Organization Name:JOHN VRTISKA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:VRTISKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-225-5496
Mailing Address - Street 1:112 ROSS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7219
Mailing Address - Country:US
Mailing Address - Phone:620-225-5496
Mailing Address - Fax:620-225-5495
Practice Address - Street 1:112 ROSS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7219
Practice Address - Country:US
Practice Address - Phone:620-225-5496
Practice Address - Fax:620-225-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST01174207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicaid
KSPENDINGMedicare ID - Type Unspecified