Healthcare Provider Details

I. General information

NPI: 1427081041
Provider Name (Legal Business Name): LINDSBORG COMMUNITY RURAL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LINCOLN ST
LINDSBORG KS
67456-2328
US

IV. Provider business mailing address

601 W LINCOLN ST
LINDSBORG KS
67456-2328
US

V. Phone/Fax

Practice location:
  • Phone: 785-227-3371
  • Fax:
Mailing address:
  • Phone: 785-227-3371
  • Fax:

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. LARRY J VAN DER WEGE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 785-227-3308