Healthcare Provider Details

I. General information

NPI: 1285681577
Provider Name (Legal Business Name): PANACEA FAMILY MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 S PLUMMER AVE
CHANUTE KS
66720-1928
US

IV. Provider business mailing address

PO BOX 843
CHANUTE KS
66720-0843
US

V. Phone/Fax

Practice location:
  • Phone: 620-432-5588
  • Fax: 620-432-5593
Mailing address:
  • Phone: 620-432-5588
  • Fax: 620-432-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: VERDON W PARHAM
Title or Position: OWNER
Credential: M.D.
Phone: 620-432-5588