Provider Demographics
NPI:1437937331
Name:TAVA CLINICAL SERVICES OF KANSAS, PA
Entity Type:Organization
Organization Name:TAVA CLINICAL SERVICES OF KANSAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-406-2869
Mailing Address - Street 1:PO BOX 581406
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1406
Mailing Address - Country:US
Mailing Address - Phone:385-406-2867
Mailing Address - Fax:801-992-8269
Practice Address - Street 1:801 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3548
Practice Address - Country:US
Practice Address - Phone:316-867-9302
Practice Address - Fax:801-992-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)