=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508841552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOKS COUNTY MEDICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 S 2ND ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67669-1966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-425-6417
-----------------------------------------------------
Fax | 785-425-6138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 S 2ND ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67669-1966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-425-6417
-----------------------------------------------------
Fax | 785-425-6138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANN RENEE TAYLOR
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 785-425-6417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 05 28153
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------