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General NPI Number Information
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NPI Number | 1467566802
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Entity Type | Organization
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Legal Business Name | FORT SCOTT FAMILY MEDICINE, P.A.
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 202 STATE ST SUITE A
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City | FORT SCOTT
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State | KS
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Zip | 66701-2031
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Country | US
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Telephone | 620-223-3950
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Fax | 620-223-1302
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Provider Business Mailing Address
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Address Line | 202 STATE ST SUITE A
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City | FORT SCOTT
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State | KS
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Zip | 66701-2031
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Country | US
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Telephone | 620-223-3950
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Fax | 620-223-1302
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICKY D KELLENBERGER
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Credential | D.O.
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Telephone | 620-223-3950
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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 |
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License Number State |
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