Provider Demographics
NPI:1851439574
Name:WESTERN KANSAS UROLOGICAL ASSOC., P.A.
Entity Type:Organization
Organization Name:WESTERN KANSAS UROLOGICAL ASSOC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-628-6014
Mailing Address - Street 1:3355 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8400
Mailing Address - Country:US
Mailing Address - Phone:941-309-7284
Mailing Address - Fax:941-390-7282
Practice Address - Street 1:3355 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8400
Practice Address - Country:US
Practice Address - Phone:941-309-7284
Practice Address - Fax:941-390-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7834Medicare ID - Type Unspecified