| Family Care Clinic Of Western Kansas, Llc | |
|
200 W Ross Blvd Dodge City KS 67801-7221 | |
| (620) 371-7300 | |
| (620) 371-7304 |
| Full Name | Family Care Clinic Of Western Kansas, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 200 W Ross Blvd, Dodge City, Kansas |
| Authorized Official Name and Position | James W. Moffitt (PRESIDENT) |
| Authorized Official Contact | 6203717300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Care Clinic Of Western Kansas, Llc 200 W Ross Blvd Dodge City KS 67801-7221 Ph: (620) 371-7300 | Family Care Clinic Of Western Kansas, Llc 200 W Ross Blvd Dodge City KS 67801-7221 Ph: (620) 371-7300 |
| NPI Number | 1780914697 |
|---|---|
| Provider Enumeration Date | 12/29/2009 |
| Last Update Date | 12/29/2009 |
| Medicare PECOS PAC ID | 0648300194 |
|---|---|
| Medicare Enrollment ID | O20100611000659 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780914697 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shawna D Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497778542 PECOS PAC ID: 0648273599 Enrollment ID: I20060814000378 |
| Provider Name | James W Moffitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346205929 PECOS PAC ID: 0840109765 Enrollment ID: I20080131000630 |
| Provider Name | Leighton James Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649428863 PECOS PAC ID: 5092760637 Enrollment ID: I20100524000382 |
| Provider Name | Emily Ann Westerman Wadel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508425141 PECOS PAC ID: 1951734276 Enrollment ID: I20191127000959 |
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