Provider Demographics
NPI:1295815041
Name:WILLIAM R. TROUP M.D.
Entity Type:Organization
Organization Name:WILLIAM R. TROUP M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-492-6230
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:101 E GREENWOOD AVE
Mailing Address - City:JOHNSON
Mailing Address - State:KS
Mailing Address - Zip Code:67855-0699
Mailing Address - Country:US
Mailing Address - Phone:620-492-6230
Mailing Address - Fax:620-492-2309
Practice Address - Street 1:101 E GREENWOOD AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:KS
Practice Address - Zip Code:67855-0699
Practice Address - Country:US
Practice Address - Phone:620-492-6230
Practice Address - Fax:620-492-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43182356Medicaid
COC338608Medicare ID - Type Unspecified
KS110230Medicare ID - Type Unspecified
D17369Medicare UPIN