Provider Demographics
NPI:1417169889
Name:THE PROSTATE TREATMENT CENTER
Entity Type:Organization
Organization Name:THE PROSTATE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-269-5000
Mailing Address - Street 1:1130 S CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2913
Mailing Address - Country:US
Mailing Address - Phone:316-269-5000
Mailing Address - Fax:316-269-0404
Practice Address - Street 1:1130 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2913
Practice Address - Country:US
Practice Address - Phone:316-269-5000
Practice Address - Fax:316-269-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430440208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111124OtherBCBS
KS111124Medicare ID - Type UnspecifiedMEDICARE
KSC96122Medicare UPIN