Healthcare Provider Details

I. General information

NPI: 1184793499
Provider Name (Legal Business Name): ASHLEY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 9TH ST
HUMBOLDT KS
66748-1908
US

IV. Provider business mailing address

PO BOX 946
CHANUTE KS
66720-0946
US

V. Phone/Fax

Practice location:
  • Phone: 620-473-2275
  • Fax: 620-473-2821
Mailing address:
  • Phone: 620-431-2500
  • Fax: 620-431-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT K THOMEN II
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 620-431-2500