Healthcare Provider Details

I. General information

NPI: 1417923780
Provider Name (Legal Business Name): PARTNERS IN FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PACK
MOUNDRIDGE KS
67107-0640
US

IV. Provider business mailing address

200 EAST PACK
MOUNDRIDGE KS
67107-0640
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-6322
  • Fax: 620-345-3038
Mailing address:
  • Phone: 620-345-6322
  • Fax: 620-345-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL D ULLOM-MINNICH
Title or Position: M.D.
Credential: M.D.
Phone: 620-345-6322