Healthcare Provider Details

I. General information

NPI: 1891069647
Provider Name (Legal Business Name): LONG TERM CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 N A ST
WELLINGTON KS
67152-4350
US

IV. Provider business mailing address

PO BOX 755
WELLINGTON KS
67152-0755
US

V. Phone/Fax

Practice location:
  • Phone: 620-440-8121
  • Fax: 620-359-1201
Mailing address:
  • Phone: 620-440-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0524781
License Number StateKS

VIII. Authorized Official

Name: DR. TAMARA LYNNE MCCUE
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 620-326-0251