Provider Demographics
NPI:1326120742
Name:EL DORADO SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:EL DORADO SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGERY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:OBRIEN
Authorized Official - Last Name:MCKESEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-320-0500
Mailing Address - Street 1:700 WEST CENTRAL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042
Mailing Address - Country:US
Mailing Address - Phone:316-320-0500
Mailing Address - Fax:316-321-0503
Practice Address - Street 1:700 WEST CENTRAL
Practice Address - Street 2:SUITE 203
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-320-0500
Practice Address - Fax:316-321-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430284208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS521450OtherFIRST GUARD
KS521450OtherFIRST GUARD
H92790Medicare UPIN