Provider Demographics
NPI:1912649443
Name:EQUIPOISE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EQUIPOISE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-330-9700
Mailing Address - Street 1:8110 E 32ND ST N STE 170
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2627
Mailing Address - Country:US
Mailing Address - Phone:316-330-9700
Mailing Address - Fax:316-330-9701
Practice Address - Street 1:8110 E 32ND ST N STE 170
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2627
Practice Address - Country:US
Practice Address - Phone:316-330-9700
Practice Address - Fax:316-330-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty