Provider Demographics
NPI:1558329508
Name:POGGI PLASTIC SURGERY, PA
Entity Type:Organization
Organization Name:POGGI PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:POGGI
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:316-269-3223
Mailing Address - Street 1:3510 N. RIDGE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1210
Mailing Address - Country:US
Mailing Address - Phone:316-269-3223
Mailing Address - Fax:316-269-3328
Practice Address - Street 1:3510 N. RIDGE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1210
Practice Address - Country:US
Practice Address - Phone:316-269-3223
Practice Address - Fax:316-269-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29591174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100422880AMedicaid
KS102156OtherBLUE CROSS/BLUE SHIELD
KS102156OtherBCBS
KS100422880AMedicaid
KS102156Medicare PIN
KS100422880AMedicaid