Healthcare Provider Details

I. General information

NPI: 1285726083
Provider Name (Legal Business Name): MARC FELTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SAINT MARYS RD SUITE 400
JUNCTION CITY KS
66441-4176
US

IV. Provider business mailing address

1106 SAINT MARYS RD STE 201
JUNCTION CITY KS
66441-4841
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-2585
  • Fax:
Mailing address:
  • Phone: 785-762-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0421032
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-21032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: