Healthcare Provider Details

I. General information

NPI: 1114041035
Provider Name (Legal Business Name): LYNDON FAMILY HEALTH CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 SW FAIRLAWN RD
TOPEKA KS
66604-2020
US

IV. Provider business mailing address

PO BOX 4795
TOPEKA KS
66604-0795
US

V. Phone/Fax

Practice location:
  • Phone: 785-478-9625
  • Fax: 785-271-4392
Mailing address:
  • Phone: 785-478-9625
  • Fax: 785-271-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number44473
License Number StateKS

VIII. Authorized Official

Name: CHERYL LYNN WEST
Title or Position: OWNER
Credential: ARNP
Phone: 785-478-9625