Provider Demographics
NPI:1710084082
Name:THE CENTER FOR REPRODUCTIVE MEDICINE
Entity Type:Organization
Organization Name:THE CENTER FOR REPRODUCTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TJADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-687-2112
Mailing Address - Street 1:9300 E 29TH ST N
Mailing Address - Street 2:STE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2182
Mailing Address - Country:US
Mailing Address - Phone:316-687-2112
Mailing Address - Fax:316-687-1260
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:STE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-687-2112
Practice Address - Fax:316-687-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1020835OtherBC/BS KS