Provider Demographics
NPI:1457484198
Name:VICTOR M. EDDY, M.D.
Entity Type:Organization
Organization Name:VICTOR M. EDDY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DREILING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-625-2551
Mailing Address - Street 1:105 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3650
Mailing Address - Country:US
Mailing Address - Phone:785-625-2551
Mailing Address - Fax:
Practice Address - Street 1:105 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3650
Practice Address - Country:US
Practice Address - Phone:785-625-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10856208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60110OtherPHS
KS016614Medicare ID - Type Unspecified