Provider Demographics
NPI:1497465637
Name:POTOMAC HEALTH OF KANSAS PC
Entity Type:Organization
Organization Name:POTOMAC HEALTH OF KANSAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-728-6740
Mailing Address - Street 1:1177 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1221
Mailing Address - Country:US
Mailing Address - Phone:201-834-4786
Mailing Address - Fax:
Practice Address - Street 1:1177 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1221
Practice Address - Country:US
Practice Address - Phone:201-834-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC HEALTH PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty