Provider Demographics
NPI:1437169778
Name:WESTERN KANSAS SURGICAL PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:WESTERN KANSAS SURGICAL PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:GURMENDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-275-3740
Mailing Address - Street 1:311 E SPRUCE ST
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5684
Mailing Address - Country:US
Mailing Address - Phone:620-275-3740
Mailing Address - Fax:620-275-3020
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5684
Practice Address - Country:US
Practice Address - Phone:620-275-3740
Practice Address - Fax:620-275-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicare ID - Type Unspecified