Healthcare Provider Details

I. General information

NPI: 1194875443
Provider Name (Legal Business Name): OBERLIN MEDICAL ARTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W COLUMBIA ST
OBERLIN KS
67749-2412
US

IV. Provider business mailing address

PO BOX 110
OBERLIN KS
67749-0110
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2221
  • Fax: 785-475-3847
Mailing address:
  • Phone: 785-472-2221
  • Fax: 785-475-3847

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: BARB D WHITNEY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 785-472-2221