Healthcare Provider Details

I. General information

NPI: 1932292273
Provider Name (Legal Business Name): DR. SHARON MITCHELL'S MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 VILLAGE PLZ
LIBERAL KS
67901-2762
US

IV. Provider business mailing address

13 VILLAGE PLZ
LIBERAL KS
67901-2762
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-0604
  • Fax: 620-624-1148
Mailing address:
  • Phone: 620-624-0604
  • Fax: 620-624-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0427259
License Number StateKS

VIII. Authorized Official

Name: DR. SHARON MITCHELL
Title or Position: DR
Credential: M.D.
Phone: 620-624-0604