|
| |
|
808 N 19th St Marysville KS 66508-1358 | |
| (785) 562-2303 | |
| (785) 562-2034 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 808 N 19th St, Marysville, Kansas |
| Authorized Official Name and Position | Therese M Landoll (CFO) |
| Authorized Official Contact | 7855622311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
808 N 19th St Marysville KS 66508-1358 Ph: (785) 562-2303 | 808 N 19th St Marysville KS 66508-1358 Ph: (785) 562-2303 |
| NPI Number | 1124049937 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124049937 | NPI | - | NPPES |
| CD1965 | Other | RAILROAD MEDICARE | |
| 110007 | Other | KS | BLUE CROSS/BLUE SHIELD KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |