Provider Demographics
NPI:1548202732
Name:TALLGRASS PRAIRIE SURGICAL SPECIALIST PA
Entity Type:Organization
Organization Name:TALLGRASS PRAIRIE SURGICAL SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DARNALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-273-4300
Mailing Address - Street 1:2201 SW WESTPORT DR
Mailing Address - Street 2:200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1914
Mailing Address - Country:US
Mailing Address - Phone:785-273-4300
Mailing Address - Fax:785-273-9654
Practice Address - Street 1:2201 SW WESTPORT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1914
Practice Address - Country:US
Practice Address - Phone:785-273-4300
Practice Address - Fax:785-273-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100221830BMedicaid
KS116527Medicare ID - Type UnspecifiedPROVIDER #