Provider Demographics
NPI:1538264338
Name:WESTERN KANSAS ANESTHESIA PA
Entity type:Organization
Organization Name:WESTERN KANSAS ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:785-628-8113
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-8113
Mailing Address - Fax:785-625-6126
Practice Address - Street 1:1904 E 29TH STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-650-0600
Practice Address - Fax:785-650-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54114367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS180062OtherBCBS
KS200564860AMedicaid
KS004656Medicare PIN