MEDICARE: WEST CENTRAL KANSAS ASSOCIATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1386490738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST CENTRAL KANSAS ASSOCIATION, INC.

Provider Business Mailing Address
First Line	:	200 S MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2920
Country	:	US
Telephone Number	:	785-483-0708
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2731
Country	:	US
Telephone Number	:	785-483-3131
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID CAUDILL
Credential	:
Telephone Number	:	785-483-0708

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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