Healthcare Provider Details

I. General information

NPI: 1578766499
Provider Name (Legal Business Name): FAMILY PHYSICIANS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 EAST STREET
IOLA KS
66749-3004
US

IV. Provider business mailing address

112 E BROAD ST
COLONY KS
66015-7286
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-3115
  • Fax: 620-365-7717
Mailing address:
  • Phone: 620-852-3550
  • Fax: 620-852-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLEN D SINGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 620-365-3115