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412 Grand Ave Stafford KS 67578-2010 | |
(620) 792-5700 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 412 Grand Ave, Stafford, Kansas |
Authorized Official Name and Position | Jyl Nokes (CO) |
Authorized Official Contact | 6207925700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1905 19th St Great Bend KS 67530-2502 Ph: (620) 792-5700 | 412 Grand Ave Stafford KS 67578-2010 Ph: (620) 792-5700 |
NPI Number | 1255856258 |
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Provider Enumeration Date | 08/10/2017 |
Last Update Date | 01/09/2025 |
Medicare PECOS PAC ID | 4486565181 |
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Medicare Enrollment ID | O20171110000221 |
Identifier | Type | State | Issuer |
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1255856258 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |