Provider Demographics
NPI:1053388652
Name:SOUTHEAST KANSAS PHYSICIAN ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:SOUTHEAST KANSAS PHYSICIAN ASSOCIATES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-431-0340
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0943
Mailing Address - Country:US
Mailing Address - Phone:620-431-0340
Mailing Address - Fax:620-431-0434
Practice Address - Street 1:1409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-0943
Practice Address - Country:US
Practice Address - Phone:620-431-0340
Practice Address - Fax:620-431-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100327080AMedicaid
KSCG3252OtherRR MEDICARE
KS100327080AMedicaid