Organization
ADDICTION TOXICOLOGY OF KANSAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY M R HAYNES MD (OWNER)
(252) 864-5790
Entity
Organization
Contact information
Practice address
3600 E HARRY ST, WICHITA, KS 67218-3713
(316) 268-5000
Mailing address
1518 E KALISPELL CT, ANDOVER, KS 67002-7982
(252) 864-5790
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
09/22/2021
Last updated
11/09/2021
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