Provider Demographics
NPI:1902395262
Name:TOPEKA PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:TOPEKA PHYSICIAN GROUP, LLC
Other - Org Name:THE UNIVERSITY OF KANSAS PHYSICIANS TOPEKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3000
Mailing Address - Street 1:1 BURTON HILLS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6195
Mailing Address - Country:US
Mailing Address - Phone:615-296-3000
Mailing Address - Fax:615-296-6227
Practice Address - Street 1:403 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:KS
Practice Address - Zip Code:66088
Practice Address - Country:US
Practice Address - Phone:785-945-3263
Practice Address - Fax:785-945-3902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOPEKA HEALTH SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty