# RENOVO MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** University Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083864219
- **Authorized official:** PROF. JOEL T ERSKIN SCD PA-C (CEO/PHYSICIAN ASSISTANT)
- **Authorized official phone:** (620) 805-5162

## Contact information

- **Practice address:** 816 N CAMPUS DR, SUITE 500, GARDEN CITY, KS 67846-6329
- **Practice address phone:** (620) 805-5162
- **Practice address fax:** (620) 805-5183
- **Mailing address:** 816 N CAMPUS DR, SUITE 500, GARDEN CITY, KS 67846-6329
- **Mailing address phone:** (620) 805-5162
- **Mailing address fax:** (620) 805-5183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | 0416265 | KS | — |
| 208D00000X | General Practice Physician | KS0434389 | KS | Yes |
| 363AS0400X | Surgical Physician Assistant | 1500265 | KS | — |
| 363LF0000X | Family Nurse Practitioner | 45404 | KS | — |

## Other

- **Enumeration date:** 09/24/2008
- **Last updated:** 03/05/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 055515 | BCBS | — |
| 01 | — | 1487634069 | NPI JOEL T. ERSKIN PA-C | KS |
| 01 | — | 1669659967 | NPI KRISTI L. SCHMITT | KS |
| 01 | — | 1730135500 | NPI | KS |
| 05 | — | 200063310F | — | KS |
| 01 | — | 659930 | FIRST GUARD | — |