Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 1903 Euclid Ave, 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 |
---|---|
240 W. 18th Street Horton KS 66439-1245 Ph: (785) 879-4357 | 1903 Euclid Ave Horton KS 66439 Ph: (785) 879-4325 |
NPI Number | 1598949364 |
---|---|
Provider Enumeration Date | 12/28/2007 |
Last Update Date | 07/16/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598949364 | NPI | - | NPPES |
200575150B | Medicaid | KS | |
110054 | Other | KS | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | H007002 (Kansas) | Primary |