Full Name | |
---|---|
Speciality | Clinic/center |
Location | 304 N Cedar St, Moran, Kansas |
Authorized Official Name and Position | Larry Raymond Peterson (CFO) |
Authorized Official Contact | 6203651026 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
304 N. Cedar St. Moran KS 66755 Ph: () - | 304 N Cedar St Moran KS 66755-4143 Ph: (620) 237-4205 |
NPI Number | 1558809814 |
---|---|
Provider Enumeration Date | 02/07/2017 |
Last Update Date | 07/01/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558809814 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |