|
| |
|
323 Second St Goff Medical Clinic Wetmore KS 66550-0249 | |
| (785) 866-4775 | |
| (785) 866-4204 |
| Full Name | |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 323 Second St, Wetmore, Kansas |
| Authorized Official Name and Position | Emma J Krogmann (OFFICE MANAGER) |
| Authorized Official Contact | 7858664775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 249 Goff Medical Clinic Wetmore KS 66550-0249 Ph: (785) 866-4775 | 323 Second St Goff Medical Clinic Wetmore KS 66550-0249 Ph: (785) 866-4775 |
| NPI Number | 1598795544 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 03/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598795544 | NPI | - | NPPES |
| 100291070B | Medicaid | KS | |
| 111034 | Other | KS | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 04 19703 (Kansas) | Secondary |
| 305R00000X | Preferred Provider Organization | (* (Not Available)) | Primary |