Provider Demographics
NPI:1578908299
Name:KANSAS ORTHOPAEDIC CENTER, PA
Entity Type:Organization
Organization Name:KANSAS ORTHOPAEDIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-838-2020
Mailing Address - Street 1:7550 W VILLAGE CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9363
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:
Practice Address - Street 1:2450 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3902
Practice Address - Country:US
Practice Address - Phone:316-838-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
KS332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0596950005Medicare NSC