Provider Demographics
NPI:1972635670
Name:FLINT HILLS PODIATRY PA
Entity Type:Organization
Organization Name:FLINT HILLS PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-539-9255
Mailing Address - Street 1:3252 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2157
Mailing Address - Country:US
Mailing Address - Phone:785-539-9255
Mailing Address - Fax:785-539-2494
Practice Address - Street 1:3252 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2157
Practice Address - Country:US
Practice Address - Phone:785-539-9255
Practice Address - Fax:785-539-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200259213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG0441OtherRR MCR
114102OtherBC
DG0441OtherRR MCR
114102Medicare PIN
KSU42527Medicare UPIN