Full Name | |
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Speciality | Clinic/Center |
Location | 105 N High St, Clyde, Kansas |
Authorized Official Name and Position | Austin M Gillard (CEO) |
Authorized Official Contact | 7856322144 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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105 N High St Clyde KS 66938 Ph: (785) 446-2226 | 105 N High St Clyde KS 66938-9428 Ph: (785) 446-2226 |
NPI Number | 1801259783 |
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Provider Enumeration Date | 03/30/2016 |
Last Update Date | 01/29/2020 |
Medicare PECOS PAC ID | 6901959436 |
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Medicare Enrollment ID | O20160719002491 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801259783 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |