Full Name | |
---|---|
Speciality | Family Medicine |
Location | 240 W 18th St, Horton, Kansas |
Authorized Official Name and Position | Tyrone L Compton (CEO) |
Authorized Official Contact | 7858794357 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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240 W. 18th Street Horton KS 66439-1245 Ph: (785) 879-4357 | 240 W 18th St Horton KS 66439 Ph: (785) 879-4357 |
NPI Number | 1952585721 |
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Provider Enumeration Date | 12/28/2007 |
Last Update Date | 07/16/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952585721 | NPI | - | NPPES |
111398 | Other | KS | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H-007-002 (Kansas) | Primary |