Healthcare Provider Details

I. General information

NPI: 1053305136
Provider Name (Legal Business Name): SALINA CLINIC L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE SUITE 100
SALINA KS
67401-4189
US

IV. Provider business mailing address

501 S SANTA FE AVE 100
SALINA KS
67401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-9631
  • Fax: 785-827-0217
Mailing address:
  • Phone: 785-827-9631
  • Fax: 785-827-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberSA 534785
License Number StateKS

VIII. Authorized Official

Name: KIM A OLIVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-827-9631