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301 S Derby Sublette KS 67877-0398 | |
(620) 675-2686 | |
(620) 675-2236 |
Full Name | |
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Speciality | Family Medicine |
Location | 301 S Derby, Sublette, Kansas |
Authorized Official Name and Position | Tina Pendergraft (ADMINISTRATOR) |
Authorized Official Contact | 6206492761 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 398 Sublette KS 67877-0398 Ph: (620) 675-2686 | 301 S Derby Sublette KS 67877-0398 Ph: (620) 675-2686 |
NPI Number | 1073706255 |
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Provider Enumeration Date | 08/22/2007 |
Last Update Date | 01/27/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073706255 | NPI | - | NPPES |
110229 | Other | KS | MEDICARE NON RURAL HEALTH |
110229 | Other | KS | NON RURAL HEALTH NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | HO41001 (Kansas) | Primary |
208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Secondary |