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General NPI Number Information
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NPI Number | 1134234073
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Entity Type | Organization
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Legal Business Name | LIFELINE FAMILY MEDICINE, P.A.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 1210 N. WASHINGTON, CLINIC B
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City | PLAINVILLE
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State | KS
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Zip | 67663
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Country | US
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Telephone | 785-434-2622
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Fax | 785-434-2577
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Provider Business Mailing Address
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Address Line | 1210 N. WASHINGTON, CLINIC B P.O. BOX 407
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City | PLAINVILLE
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State | KS
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Zip | 67663-0407
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Country | US
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Telephone | 785-434-2622
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Fax | 785-434-2577
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LYNN R FISHER
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Credential | M.D.
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Telephone | 785-434-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-30818
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License Number State | KS
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