Provider Demographics
NPI:1710936521
Name:CENTRAL KANSAS UROLOGY, PA
Entity Type:Organization
Organization Name:CENTRAL KANSAS UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-653-7306
Mailing Address - Street 1:353 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1715
Mailing Address - Country:US
Mailing Address - Phone:620-653-7306
Mailing Address - Fax:620-653-2968
Practice Address - Street 1:353 W 10TH ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1715
Practice Address - Country:US
Practice Address - Phone:620-653-7306
Practice Address - Fax:620-653-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS009585Medicare ID - Type Unspecified
KSEO8799Medicare UPIN