Provider Demographics
NPI:1487841474
Name:ANTHONY J CANFIELD MD FACS, L
Entity Type:Organization
Organization Name:ANTHONY J CANFIELD MD FACS, L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:620-624-4946
Mailing Address - Street 1:1411 W 15TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2288
Mailing Address - Country:US
Mailing Address - Phone:620-624-4946
Mailing Address - Fax:620-624-0952
Practice Address - Street 1:1411 W 15TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2288
Practice Address - Country:US
Practice Address - Phone:620-624-4946
Practice Address - Fax:620-624-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100396510AMedicaid
KS111368OtherBCBSKS
KSDG2696OtherMEDICARE RAILROAD
KSDG2696OtherMEDICARE RAILROAD
KS100396510AMedicaid