Healthcare Provider Details

I. General information

NPI: 1932650660
Provider Name (Legal Business Name): JAMES RYCKERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E GRANT AVE
GREENSBURG KS
67054-2708
US

IV. Provider business mailing address

610 E GRANT AVE
GREENSBURG KS
67054-2708
US

V. Phone/Fax

Practice location:
  • Phone: 620-723-2272
  • Fax: 620-723-3450
Mailing address:
  • Phone: 620-723-2272
  • Fax: 620-723-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9700
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: