Healthcare Provider Details

I. General information

NPI: 1225076854
Provider Name (Legal Business Name): WHEATLAND HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W RAILROAD ST
SILVER LAKE KS
66539-9458
US

IV. Provider business mailing address

224 W RAILROAD ST PO BOX 67
SILVER LAKE KS
66539-9458
US

V. Phone/Fax

Practice location:
  • Phone: 785-582-5400
  • Fax: 785-582-5406
Mailing address:
  • Phone: 785-582-5400
  • Fax: 785-582-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number45025
License Number StateKS

VIII. Authorized Official

Name: MS. SHERRY SUE RICKEL
Title or Position: PRESIDENT/OWNER
Credential: ARNP-C
Phone: 785-582-5400