# EASTERN KANSAS HEALTH CARE SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750302832
- **Authorized official:** MR. SIROUS NOURBAKHSH PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (785) 350-3111

## Contact information

- **Practice address:** 112 TUMBLEWEED DR, LAWRENCE, KS 66049-4151
- **Practice address phone:** (785) 841-4707
- **Mailing address:** 112 TUMBLEWEED DR, LAWRENCE, KS 66049-4151
- **Mailing address phone:** (785) 841-4707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 15-00217 | KS | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 08/22/2020