Healthcare Provider Details

I. General information

NPI: 1992730592
Provider Name (Legal Business Name): ROOKS COUNTY MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S COLORADO ST
PLAINVILLE KS
67663-2505
US

IV. Provider business mailing address

623 S 2ND ST
STOCKTON KS
67669-1966
US

V. Phone/Fax

Practice location:
  • Phone: 785-425-6417
  • Fax: 785-425-6138
Mailing address:
  • Phone: 785-425-6417
  • Fax: 785-425-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0528153
License Number StateKS

VIII. Authorized Official

Name: DR. ANN RENEE TAYLOR
Title or Position: PRESIDENT
Credential: D O
Phone: 785-425-6417