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206 Grand Ave St Marys KS 66536-1637 | |
(785) 437-3734 | |
(785) 437-6186 |
Full Name | |
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Speciality | Clinic/Center |
Location | 206 Grand Ave, St Marys, Kansas |
Authorized Official Name and Position | Todd Willert (CEO) |
Authorized Official Contact | 7858895002 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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206 Grand Ave St Marys KS 66536-1637 Ph: (785) 437-3734 | 206 Grand Ave St Marys KS 66536-1637 Ph: (785) 437-3734 |
NPI Number | 1275504839 |
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Provider Enumeration Date | 01/31/2006 |
Last Update Date | 06/02/2020 |
Medicare PECOS PAC ID | 8325031529 |
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Medicare Enrollment ID | O20040601000057 |
Identifier | Type | State | Issuer |
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1275504839 | NPI | - | NPPES |
100110130B | Medicaid | KS | |
001440 | Other | KS | BCBS PLAN 65 |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | H075001 (Kansas) | Primary |