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619 S Clark Ave Lyons KS 67554-3003 | |
(620) 257-5173 | |
(620) 257-2608 |
Full Name | |
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Speciality | Family Medicine |
Location | 619 S Clark Ave, Lyons, Kansas |
Authorized Official Name and Position | Weston Tallman (CFO) |
Authorized Official Contact | 6202575173 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 828 Lyons KS 67554-0828 Ph: (620) 257-5173 | 619 S Clark Ave Lyons KS 67554-3003 Ph: (620) 257-5173 |
NPI Number | 1194002261 |
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Provider Enumeration Date | 11/03/2011 |
Last Update Date | 10/31/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194002261 | NPI | - | NPPES |
100099160A | Medicaid | KS | |
30003942210001 | Medicaid | KS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H080001 (Kansas) | Primary |