Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 204 North Main, Dexter, Kansas |
Authorized Official Name and Position | Faye E Melton (CLINIC MANAGER) |
Authorized Official Contact | 6207582221 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 240 204 North Main Dexter KS 67038-0240 Ph: (620) 876-5863 | 204 North Main Dexter KS 67038 Ph: (620) 876-5863 |
NPI Number | 1083633374 |
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Provider Enumeration Date | 07/18/2006 |
Last Update Date | 12/19/2011 |
Medicare PECOS PAC ID | 5294648937 |
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Medicare Enrollment ID | O20170606001495 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083633374 | NPI | - | NPPES |
100005090H | Medicaid | KS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 173433 (Kansas) | Primary |