Provider Demographics
NPI:1508892191
Name:NEUROSURGERY ASSIST, LLC
Entity Type:Organization
Organization Name:NEUROSURGERY ASSIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-269-5000
Mailing Address - Street 1:6120 SHADYBROOK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1862
Mailing Address - Country:US
Mailing Address - Phone:316-269-5000
Mailing Address - Fax:316-269-0404
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111120OtherBCBS
KS200371470AMedicaid
KS111120Medicare ID - Type Unspecified