Provider Demographics
NPI:1629232004
Name:KANSAS PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:KANSAS PHYSICIANS GROUP, LLC
Other - Org Name:ENDOVASCULAR SPECIALISTS OF WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OF GALICHIA HEART HOSPITAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-2601
Mailing Address - Street 1:PO BOX 47163
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7163
Mailing Address - Country:US
Mailing Address - Phone:316-858-2681
Mailing Address - Fax:
Practice Address - Street 1:2600 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-684-3838
Practice Address - Fax:316-858-2077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALICHIA HEART HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619973906OtherJAMES AM SMITH, DO
KSKA1199Medicare PIN