Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 415 Washington, Rolla, Kansas |
Authorized Official Name and Position | James L Forrest (CFO) |
Authorized Official Contact | 6206975252 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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445 Hilltop Elkhart KS 67950 Ph: (620) 697-5252 | 415 Washington Rolla KS 67954 Ph: (620) 697-2175 |
NPI Number | 1326416025 |
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Provider Enumeration Date | 09/11/2015 |
Last Update Date | 09/11/2015 |
Medicare PECOS PAC ID | 5395644637 |
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Medicare Enrollment ID | O20151029002828 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326416025 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |