MEDICARE: CLEARWATER FAMILY PRACTICE PA

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	261QP2300X	Primary Care Clinic/Center	0518527	KS

General Provider Information

NPI Number	:	1548361538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATER FAMILY PRACTICE PA

Provider Business Mailing Address
First Line	:	101 E ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7824
Country	:	US
Telephone Number	:	620-584-2055
Fax Number	:	620-584-2032

Provider Business Practice Location Address
First Line	:	101 E ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7824
Country	:	US
Telephone Number	:	620-584-2055
Fax Number	:	620-584-2032

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID IRA PAPISH
Credential	:	D.O.
Telephone Number	:	620-584-2055

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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