Healthcare Provider Details

I. General information

NPI: 1841470093
Provider Name (Legal Business Name): FAMILY MEDCENTERS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N ROSE HILL RD
ROSE HILL KS
67133-9428
US

IV. Provider business mailing address

323 N ROSE HILL RD
ROSE HILL KS
67133-9428
US

V. Phone/Fax

Practice location:
  • Phone: 316-776-2422
  • Fax: 316-776-2879
Mailing address:
  • Phone: 316-776-2422
  • Fax: 316-776-2879

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: DAVID W. NIEDEREE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 316-788-6963