Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 04-30880 | KS |
NPI | 1104844836 |
---|---|
Provider Name | Geoffrey M Vincent |
First Address | El Dorado, KS 67042-4030 |
Second Address | El Dorado, KS 67042-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105276 | BC/BS OF KANSAS (01) | KS |
200270790B | (05) | KS |
H68383 | (02) | KS |