Organization
AVALON ADVANCED HEALTH, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHALL EIDENBERG D.O. (VICE PRESIDENT/CMO)
(785) 301-2639
Entity
Organization
Contact information
Practice address
1011 W 27TH ST, SUITE F4, HAYS, KS 67601-4823
(785) 301-2639
Mailing address
1011 W 27TH ST, SUITE F4, HAYS, KS 67601-4823
(785) 301-2639
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
05-32944
KS
261Q00000X
Clinic/Center
Primary
05-32944
KS
Other
Enumeration date
05/05/2015
Last updated
08/12/2015
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