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General NPI Number Information
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NPI Number | 1174667174
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Entity Type | Organization
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Legal Business Name | SHAWNEE FAMILY CARE PA
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5949 NIEMAN RD
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City | SHAWNEE
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State | KS
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Zip | 66203-2907
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Country | US
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Telephone | 913-631-6114
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Fax | 913-631-5263
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Provider Business Mailing Address
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Address Line | 5949 NIEMAN RD
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City | SHAWNEE
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State | KS
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Zip | 66203-2907
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Country | US
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Telephone | 913-631-6114
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Fax | 913-631-5263
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARTHA A WARD
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Credential | CPC
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Telephone | 913-631-6114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0423330
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License Number State | KS
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