Provider Demographics
NPI:1841332756
Name:SUHAIL ANSARI MD
Entity type:Organization
Organization Name:SUHAIL ANSARI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUHAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-6222
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905
Mailing Address - Country:US
Mailing Address - Phone:620-624-6222
Mailing Address - Fax:620-624-5413
Practice Address - Street 1:2138 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2012
Practice Address - Country:US
Practice Address - Phone:620-624-6222
Practice Address - Fax:620-624-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0482742332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5772100001Medicare NSC
KS115607Medicare PIN
KSH27938Medicare UPIN