Provider Demographics
NPI:1134572670
Name:HEALTHSTAT ONSITE AMSTED GW KANSAS
Entity type:Organization
Organization Name:HEALTHSTAT ONSITE AMSTED GW KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-529-6161
Mailing Address - Street 1:4651 CHARLOTTE PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1956
Mailing Address - Country:US
Mailing Address - Phone:704-529-6161
Mailing Address - Fax:
Practice Address - Street 1:7111 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-2406
Practice Address - Country:US
Practice Address - Phone:704-936-5546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty