Organization
COTTON O'NEIL CLINIC REVOCABLE TRUST
Active
Other names
Cotton O'Neil Lab
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY KOEHN (ENROLLMENT COORDINATOR)
(785) 354-5201
Entity
Organization
Contact information
Practice address
901 SW GARFIELD AVE, TOPEKA, KS 66606-1670
(785) 354-9591
(785) 354-4268
Mailing address
901 SW GARFIELD AVE, TOPEKA, KS 66606-1670
(785) 354-9591
(785) 354-4268
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100217350T
—
KS
01
—
130156
MEDICARE PTAN
—
Enumeration date
03/09/2007
Last updated
12/19/2023
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