Provider Demographics
NPI:1598998130
Name:SHAWNEE ORAL SURGERY, LC
Entity Type:Organization
Organization Name:SHAWNEE ORAL SURGERY, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-979-9494
Mailing Address - Street 1:6844 SILVERHEEL STREET
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-5300
Mailing Address - Country:US
Mailing Address - Phone:913-948-7766
Mailing Address - Fax:913-948-7769
Practice Address - Street 1:6844 SILVERHEEL STREET
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-5300
Practice Address - Country:US
Practice Address - Phone:913-948-7766
Practice Address - Fax:913-948-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100224610FMedicaid
KS100224610FMedicaid