Healthcare Provider Details

I. General information

NPI: 1013067768
Provider Name (Legal Business Name): MCLOUTH MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SOUTH UNION STREET
MC LOUTH KS
66054-0160
US

IV. Provider business mailing address

PO BOX 160 313 S. UNION STREET
MC LOUTH KS
66054-0160
US

V. Phone/Fax

Practice location:
  • Phone: 913-796-6116
  • Fax: 913-796-2222
Mailing address:
  • Phone: 913-796-6116
  • Fax: 913-796-2222

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: MRS. LORENE L STEPHAN
Title or Position: PARTNER
Credential: ARNP-C
Phone: 913-796-6116