Provider Demographics
NPI:1023101656
Name:ADDICTION SPECIALISTS OF KANSAS, INC,
Entity type:Organization
Organization Name:ADDICTION SPECIALISTS OF KANSAS, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
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 PARKWAY
Mailing Address - Street 2:SUITE 135
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:316-685-8247
Practice Address - Street 1:650 N CARRIAGE PARKWAY
Practice Address - Street 2:SUITE 135
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:316-685-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116023OtherBCBS PROVIDER NUMBER
KS052256Medicare ID - Type Unspecified