Organization
ULTRA CLASSIC ANESTHESIA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER FRYETT (PRESIDENT)
(620) 664-6761
Entity
Organization
Contact information
Practice address
1701 E 23RD AVE, HUTCHINSON, KS 67502-1105
(620) 664-6761
Mailing address
30 TOMAHAWK RD, HUTCHINSON, KS 67502-2935
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC3545
RAILROAD MEDICARE
—
Enumeration date
02/26/2006
Last updated
08/22/2020
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