Provider Demographics
NPI:1265760524
Name:STORMONT-VAIL WORKCARE REVOCABLE TRUST
Entity type:Organization
Organization Name:STORMONT-VAIL WORKCARE REVOCABLE TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICIAN SUPPORT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:785-354-5880
Mailing Address - Street 1:1504 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1632
Mailing Address - Country:US
Mailing Address - Phone:785-270-8605
Mailing Address - Fax:785-270-8606
Practice Address - Street 1:1504 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1632
Practice Address - Country:US
Practice Address - Phone:785-270-8605
Practice Address - Fax:785-270-8606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STORMONT-VAIL HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty