Provider Demographics
NPI:1821271941
Name:ADDICTION SPECIALISTS OF KANSAS
Entity Type:Organization
Organization Name:ADDICTION SPECIALISTS OF KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-685-4700
Mailing Address - Street 1:650 N CARRIAGE PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4514
Mailing Address - Country:US
Mailing Address - Phone:316-685-4700
Mailing Address - Fax:
Practice Address - Street 1:650 N CARRIAGE PKWY STE 135
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4514
Practice Address - Country:US
Practice Address - Phone:316-685-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION SPECIALISTS OF KANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052256Medicare Oscar/Certification