Provider Demographics
NPI:1437101557
Name:OB-GYN ASSOCIATES OF SOUTHWEST KANSAS CHARTERED
Entity Type:Organization
Organization Name:OB-GYN ASSOCIATES OF SOUTHWEST KANSAS CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-3811
Mailing Address - Street 1:PO BOX 2529
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-2529
Mailing Address - Country:US
Mailing Address - Phone:620-624-3811
Mailing Address - Fax:620-624-3186
Practice Address - Street 1:222 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2448
Practice Address - Country:US
Practice Address - Phone:620-624-3811
Practice Address - Fax:620-624-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016459Medicare ID - Type Unspecified