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761 W 175th St S Caldwell KS 67022-8301 | |
(620) 845-6492 | |
(620) 845-2518 |
Full Name | |
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Speciality | Clinic/Center |
Location | 761 W 175th St S, Caldwell, Kansas |
Authorized Official Name and Position | Brooke Bollman (CEO) |
Authorized Official Contact | 6208456492 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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761 W 175th St S Caldwell KS 67022-8301 Ph: (620) 845-6492 | 761 W 175th St S Caldwell KS 67022-8301 Ph: (620) 845-6492 |
NPI Number | 1881327153 |
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Provider Enumeration Date | 07/05/2022 |
Last Update Date | 01/27/2023 |
Medicare PECOS PAC ID | 6103925268 |
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Medicare Enrollment ID | O20221004003580 |
Identifier | Type | State | Issuer |
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1881327153 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |