Provider Demographics
NPI:1134420821
Name:PS127&JN434, LLC
Entity type:Organization
Organization Name:PS127&JN434, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-408-5228
Mailing Address - Street 1:6021 SW 29TH ST STE A
Mailing Address - Street 2:PMB 358
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6201
Mailing Address - Country:US
Mailing Address - Phone:785-408-5228
Mailing Address - Fax:785-783-8026
Practice Address - Street 1:2655 SW WANAMAKER RD STE H
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4477
Practice Address - Country:US
Practice Address - Phone:785-408-5228
Practice Address - Fax:785-783-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2048Medicare PIN