Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 214 W Main St, Logan, Kansas |
Authorized Official Name and Position | Rhonda L Kellerman (CLINIC ADMINISTRATOR) |
Authorized Official Contact | 7855435211 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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214 W Main St P.o. Box 173 Logan KS 67646-9764 Ph: (785) 689-4220 | 214 W Main St Logan KS 67646-9764 Ph: (785) 689-4220 |
NPI Number | 1619913613 |
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Provider Enumeration Date | 06/20/2006 |
Last Update Date | 04/23/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619913613 | NPI | - | NPPES |
100409050C | Medicaid | KS |