| Coffeyville Family Practice Clinic, P.a. | |
|
209 W 7th St Coffeyville KS 67337-4903 | |
| (620) 251-1100 | |
| (620) 251-7466 |
| Full Name | Coffeyville Family Practice Clinic, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 209 W 7th St, Coffeyville, Kansas |
| Authorized Official Name and Position | James L. Christensen (DOCTOR) |
| Authorized Official Contact | 6202511100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coffeyville Family Practice Clinic, P.a. Po Box 564 Coffeyville KS 67337-0564 Ph: (620) 251-1100 | Coffeyville Family Practice Clinic, P.a. 209 W 7th St Coffeyville KS 67337-4903 Ph: (620) 251-1100 |
| NPI Number | 1083689327 |
|---|---|
| Provider Enumeration Date | 02/21/2006 |
| Last Update Date | 06/06/2013 |
| Medicare PECOS PAC ID | 2466405725 |
|---|---|
| Medicare Enrollment ID | O20050225000766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083689327 | NPI | - | NPPES |
| 100722460A | Other | OK | OKLAHOMA MEDICAID |
| 100098700A | Medicaid | KS | |
| 009974 | Other | KS | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James L Christensen |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1447238688 PECOS PAC ID: 8729035803 Enrollment ID: I20050331000826 |
| Provider Name | Stacey L Weil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144570672 PECOS PAC ID: 5496905770 Enrollment ID: I20130503000232 |
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