Provider Demographics
NPI:1184955023
Name:JACQUELINE S ORENDER DO LLC
Entity type:Organization
Organization Name:JACQUELINE S ORENDER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-231-3132
Mailing Address - Street 1:2305 S. TUCKER TERRACE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2026
Mailing Address - Country:US
Mailing Address - Phone:620-231-3132
Mailing Address - Fax:620-231-3133
Practice Address - Street 1:2305 S. TUCKER TERRACE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6623
Practice Address - Country:US
Practice Address - Phone:620-231-3132
Practice Address - Fax:620-231-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0529686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0529686OtherKANSAS LICENSE