Provider Demographics
NPI:1801183108
Name:OLSON MEDICAL LLC
Entity Type:Organization
Organization Name:OLSON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-421-2727
Mailing Address - Street 1:2515 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2727
Mailing Address - Country:US
Mailing Address - Phone:620-421-2727
Mailing Address - Fax:620-421-2744
Practice Address - Street 1:2515 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2727
Practice Address - Country:US
Practice Address - Phone:620-421-2727
Practice Address - Fax:620-421-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS358751OtherBLUE CROSS BLUE SHIELD
KS358751OtherBLUE CROSS BLUE SHIELD