Full Name | |
---|---|
Speciality | Family Medicine |
Location | 2509 Avenue E, Wilson, Kansas |
Authorized Official Name and Position | James Kirkbride (CEO) |
Authorized Official Contact | 7854723111 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1602 Aylward Ave Ellsworth KS 67439-2541 Ph: (785) 472-3111 | 2509 Avenue E Wilson KS 67490 Ph: (785) 658-3688 |
NPI Number | 1215937263 |
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Provider Enumeration Date | 07/29/2005 |
Last Update Date | 03/19/2024 |
Medicare PECOS PAC ID | 5395643357 |
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Medicare Enrollment ID | O20040220000007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215937263 | NPI | - | NPPES |
30003930830001 | Medicaid | KS | |
1387 | Other | KS | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Kansas) | Primary |