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1415 N Penn Ave Independence KS 67301-2222 | |
(620) 331-2400 | |
(620) 331-0747 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1415 N Penn Ave, Independence, Kansas |
Authorized Official Name and Position | Lori C Smith (CFO) |
Authorized Official Contact | 6203258388 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 360 Neodesha KS 66757-0360 Ph: (620) 325-2611 | 1415 N Penn Ave Independence KS 67301-2222 Ph: (620) 331-2400 |
NPI Number | 1003251802 |
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Provider Enumeration Date | 05/07/2013 |
Last Update Date | 09/25/2024 |
Medicare PECOS PAC ID | 2163656208 |
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Medicare Enrollment ID | O20131003000610 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003251802 | NPI | - | NPPES |
012213 | Other | KS | MEDICARE PART B PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Robert M Osborn Do Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 N. 14th St., Independence, KS 67301 Phone: 620-331-2070 | |