Organization
KANSAS TRAUMA AND CRITICAL CARE SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A BOLTON (PATIENT ACCOUNTS MANAGER)
(316) 962-3205
Entity
Organization
Contact information
Practice address
550 N HILLSIDE ST, WICHITA, KS 67214-4910
(316) 962-3150
(316) 962-7334
Mailing address
PO BOX 47490, WICHITA, KS 67201-7490
(316) 962-3150
(316) 962-7334
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110906
BLUE CROSS BLUE SHIELD
KS
Enumeration date
03/08/2006
Last updated
08/22/2020
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