Prairie Endoscopy LLC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

License

04-30240 Issued in KS

Legal business name

PRAIRIE ENDOSCOPY LLC

Practice address

12115 E 21St St N
Suite 107
Wichita, KS 67206-3567

Phone

(316) 440-7000

Fax

(316) 440-7006

NPI assigned

Jun 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey P Davis, MD

Title

Sole Owner

Phone

(316) 440-7000

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403654400000",
    "number": "1699189043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12115 E 21ST ST N",
            "address_2": "SUITE 107",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063567",
            "telephone_number": "316-440-7000",
            "fax_number": "316-440-7006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12115 E 21ST ST N",
            "address_2": "SUITE 107",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063567",
            "telephone_number": "316-440-7000",
            "fax_number": "316-440-7006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE ENDOSCOPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-13",
        "last_updated": "2014-06-25",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "316-440-7000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-30240",
            "primary": false
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "KS",
            "license": "04-30240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endoscopy Clinic/Center in Wichita, KS
• Providers in Wichita, KS by specialty
• Endoscopy Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.