Healthcare Provider Details

I. General information

NPI: 1053374579
Provider Name (Legal Business Name): HIGH PLAINS MEDICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PLAZA DR
LIBERAL KS
67901-2743
US

IV. Provider business mailing address

2 PLAZA DR
LIBERAL KS
67901-2743
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-5691
  • Fax: 620-624-3656
Mailing address:
  • Phone: 620-624-5691
  • Fax: 620-624-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MANDI MILHON
Title or Position: BILLER
Credential:
Phone: 620-624-5691