Provider Demographics
NPI:1598864001
Name:PASTOR R CAUSIN JR. M.D., L.L.C.
Entity Type:Organization
Organization Name:PASTOR R CAUSIN JR. M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PASTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAUSIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:316-609-3020
Mailing Address - Street 1:5051 E LINCOLN ST
Mailing Address - Street 2:10-A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2416
Mailing Address - Country:US
Mailing Address - Phone:316-683-8849
Mailing Address - Fax:316-260-2611
Practice Address - Street 1:3223 N WEBB RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8175
Practice Address - Country:US
Practice Address - Phone:316-609-3020
Practice Address - Fax:316-609-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429554204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420530AMedicaid
KS105406OtherMEDICARE PTAN
KS100420530AMedicaid
KS105406OtherMEDICARE PTAN