Provider Demographics
NPI:1790905446
Name:KANSAS STATE UNIVERSITY
Entity Type:Organization
Organization Name:KANSAS STATE UNIVERSITY
Other - Org Name:KSU AUDIOLOGY DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:785-532-6879
Mailing Address - Street 1:139 CAMPUS CREEK COMPLEX
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66506-7500
Mailing Address - Country:US
Mailing Address - Phone:785-532-6879
Mailing Address - Fax:785-532-6523
Practice Address - Street 1:139 CAMPUS CREEK COMPLEX
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66506-7500
Practice Address - Country:US
Practice Address - Phone:785-532-6879
Practice Address - Fax:785-532-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011879Medicare UPIN