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General NPI Number Information
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NPI Number | 1548813520
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL KANSAS CLINIC LLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 6403 PATTERSON PKWY
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City | ARKANSAS CITY
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State | KS
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Zip | 67005-5701
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Country | US
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Telephone | 620-447-5711
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Fax | 620-441-5891
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Provider Business Mailing Address
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Address Line | 6403 PATTERSON PKWY
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City | ARKANSAS CITY
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State | KS
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Zip | 67005-5701
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Country | US
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Telephone | 620-447-5711
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Fax | 620-441-5891
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Authorized Official
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Title or Position | CEO
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Name | JEFF BOWMAN
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Credential |
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Telephone | 620-441-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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