Provider Demographics
NPI:1477979417
Name:MID-KANSAS PM&R LLC
Entity Type:Organization
Organization Name:MID-KANSAS PM&R LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'BRIEN-LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-640-8027
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67016-0267
Mailing Address - Country:US
Mailing Address - Phone:316-640-8026
Mailing Address - Fax:817-284-3425
Practice Address - Street 1:1701 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1105
Practice Address - Country:US
Practice Address - Phone:620-513-4100
Practice Address - Fax:817-284-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty