Provider Demographics
NPI:1811108889
Name:S. W. HAAG, P.C.
Entity type:Organization
Organization Name:S. W. HAAG, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-236-7322
Mailing Address - Street 1:507 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHETOPA
Mailing Address - State:KS
Mailing Address - Zip Code:67336-9192
Mailing Address - Country:US
Mailing Address - Phone:620-236-7322
Mailing Address - Fax:620-236-7323
Practice Address - Street 1:507 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CHETOPA
Practice Address - State:KS
Practice Address - Zip Code:67336-9192
Practice Address - Country:US
Practice Address - Phone:620-236-7322
Practice Address - Fax:620-236-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425012261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA00961Medicare UPIN
KS110534Medicare ID - Type UnspecifiedMEDICARE B