Healthcare Provider Details

I. General information

NPI: 1346246105
Provider Name (Legal Business Name): CHARLES WESLEY POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N 13TH ST
LOUISBURG KS
66053-3520
US

IV. Provider business mailing address

201 N 13TH ST
LOUISBURG KS
66053-3520
US

V. Phone/Fax

Practice location:
  • Phone: 913-206-3691
  • Fax:
Mailing address:
  • Phone: 913-206-3691
  • Fax: 913-557-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2000146137
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2000146137
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2000146137
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: