Provider Demographics
NPI:1417920653
Name:KANSAS JOINT & SPINE INSTITUTE
Entity Type:Organization
Organization Name:KANSAS JOINT & SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK-BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-771-4009
Mailing Address - Street 1:10100 SHANNON WOODS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226
Mailing Address - Country:US
Mailing Address - Phone:316-858-1900
Mailing Address - Fax:316-858-1905
Practice Address - Street 1:10100 SHANNON WOODS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-858-1900
Practice Address - Fax:316-858-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100407900AMedicaid
KS110702Medicare ID - Type Unspecified
KS100407900AMedicaid