Provider Demographics
NPI:1437139979
Name:KANSAS ORTHOPAEDIC CENTER, P.A.
Entity Type:Organization
Organization Name:KANSAS ORTHOPAEDIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-838-2020
Mailing Address - Street 1:7550 WEST VILLAGE CIRCLE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:316-838-7574
Practice Address - Street 1:7550 WEST VILLAGE CIRCLE
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-838-2020
Practice Address - Fax:316-838-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC08447018OtherNORIDIAN DME SUBMITTER ID
KS100215120AMedicaid
KS100215120AMedicaid
KS016535KAMedicare PIN