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1903 Euclid Ave Horton KS 66439-1238 | |
(785) 486-2998 | |
(785) 486-2736 |
Full Name | |
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Speciality | Family Medicine |
Location | 1903 Euclid Ave, Horton, Kansas |
Authorized Official Name and Position | Dale A White (CFO) |
Authorized Official Contact | 7854862642 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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240 W 18th St Horton KS 66439-1245 Ph: (785) 486-2642 | 1903 Euclid Ave Horton KS 66439-1238 Ph: (785) 486-2998 |
NPI Number | 1518993377 |
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Provider Enumeration Date | 06/24/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518993377 | NPI | - | NPPES |
110054 | Other | KS | BLUE SHIELD |
664990 | Other | KS | FIRST GUARD HEALTH PLAN |
105444 | Other | KS | BLUE SHIELD |
426979 | Other | KS | BLUE SHIELD |
426995 | Other | KS | BLUE SHIELD |
928432 | Other | KS | FIRST GUARD HEALTH PLAN |
426715 | Other | KS | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H-007-002 (Kansas) | Primary |