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General NPI Number Information
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NPI Number | 1629252366
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Entity Type | Organization
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Legal Business Name | ST MARYS FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 515 W BERTRAND AVE
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City | SAINT MARYS
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State | KS
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Zip | 66536-1618
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Country | US
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Telephone | 785-437-2105
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Fax | 785-437-2104
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Provider Business Mailing Address
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Address Line | 515 W BERTRAND AVE P.O. BOX 56
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City | SAINT MARYS
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State | KS
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Zip | 66536-1618
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Country | US
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Telephone | 785-437-2105
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Fax | 785-437-2104
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID BRADLEY JONES
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Credential | M.D.
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Telephone | 785-437-2105
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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 | 04-21765
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License Number State | KS
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