Provider Demographics
NPI:1275501512
Name:NORTHWEST KANSAS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTHWEST KANSAS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HOLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-650-0600
Mailing Address - Street 1:1904 E 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2008
Mailing Address - Country:US
Mailing Address - Phone:785-650-0600
Mailing Address - Fax:785-650-0143
Practice Address - Street 1:1904 E 29TH STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2008
Practice Address - Country:US
Practice Address - Phone:785-650-0600
Practice Address - Fax:785-650-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-11
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS026001261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100381600AMedicaid
KS112208OtherBCBS
KS112208OtherBCBS
X53016Medicare UPIN