| |
112 N Main St Cunningham KS 67035-8802 | |
(620) 532-0295 | |
(855) 290-4906 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 112 N Main St, Cunningham, Kansas |
Authorized Official Name and Position | Lacy Drosselmeyer (COMPLIANCE SPECIALIST) |
Authorized Official Contact | 6205320281 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
750 W D Ave Kingman KS 67068-1266 Ph: (620) 532-0295 | 112 N Main St Cunningham KS 67035-8802 Ph: (620) 532-0295 |
NPI Number | 1437542073 |
---|---|
Provider Enumeration Date | 03/06/2015 |
Last Update Date | 11/08/2022 |
Medicare PECOS PAC ID | 5799683694 |
---|---|
Medicare Enrollment ID | O20150508000383 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437542073 | NPI | - | NPPES |
30003916630005 | Medicaid | KS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Joseph M Gerber |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1114549177 PECOS PAC ID: 9234554494 Enrollment ID: I20230615003064 |