Provider Demographics
NPI:1871592550
Name:PITTS, JOSHUA BLAINE (CPO, FAAOP)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:BLAINE
Last Name:PITTS
Suffix:
Gender:M
Credentials:CPO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. 1163
Mailing Address - Street 2:22215 TUPPER STREET, SUITE B
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-1163
Mailing Address - Country:US
Mailing Address - Phone:620-402-6789
Mailing Address - Fax:620-402-6791
Practice Address - Street 1:22215 TUPPER STREET
Practice Address - Street 2:SUITE B
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-1163
Practice Address - Country:US
Practice Address - Phone:620-402-6789
Practice Address - Fax:620-402-6791
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1871592550OtherNPI
KS6895730001Medicare NSC
KS48-4857600OtherEIN