| NPI | 1235451832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS WAYNE SULLIVAN Owner 785-691-7325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KS 01-05275) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: KS 01-05275) |
| 305S00000X Point of Service (Licence: KS 01-05275) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |