Provider Demographics
NPI:1518012673
Name:KANSAS NEUROLOGICAL INSTITUTE
Entity Type:Organization
Organization Name:KANSAS NEUROLOGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-296-5301
Mailing Address - Street 1:3107 SW 21ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3245
Mailing Address - Country:US
Mailing Address - Phone:785-296-5301
Mailing Address - Fax:785-296-0707
Practice Address - Street 1:3107 SW 21ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3245
Practice Address - Country:US
Practice Address - Phone:785-296-5301
Practice Address - Fax:785-296-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X
KS1353996081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual DisabilitiesGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty