Provider Demographics
NPI:1568823524
Name:CITY OF GALENA - KANSAS
Entity Type:Organization
Organization Name:CITY OF GALENA - KANSAS
Other - Org Name:PREMIER SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-783-4614
Mailing Address - Street 1:1619 K66
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4306
Mailing Address - Country:US
Mailing Address - Phone:620-783-1732
Mailing Address - Fax:620-783-4686
Practice Address - Street 1:198 FOUR STATES DR
Practice Address - Street 2:SUITE 8
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4304
Practice Address - Country:US
Practice Address - Phone:620-461-0101
Practice Address - Fax:620-461-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3899Medicare PIN