Healthcare Provider Details

I. General information

NPI: 1912966854
Provider Name (Legal Business Name): THE CHILDREN'S CLINIC OF MIAMI COUNTY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/22/2014
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: 913-294-2482
  • Fax:
Mailing address:
  • Phone: 913-294-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES WESLEY POWELL
Title or Position: OWNER & PHYSICIAN
Credential: M.D.
Phone: 913-294-2482