Provider Demographics
NPI:1477015782
Name:MIDKANSAS NEUROCRITICAL SERVICES LLC
Entity Type:Organization
Organization Name:MIDKANSAS NEUROCRITICAL SERVICES LLC
Other - Org Name:MIDKANSAS NEUROCRITICAL SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAXMI
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:DHAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-776-9495
Mailing Address - Street 1:241 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4903
Mailing Address - Country:US
Mailing Address - Phone:316-776-9495
Mailing Address - Fax:316-616-2095
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:169-623-3043
Practice Address - Fax:316-616-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty