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General NPI Number Information
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NPI Number | 1750325197
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Entity Type | Organization
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Legal Business Name | NORTHEAST KANSAS CENTER FOR HEALTH AND WELLNESS, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 240 W 18TH ST
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City | HORTON
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State | KS
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Zip | 66439-1245
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Country | US
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Telephone | 785-486-2642
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Fax | 785-486-2842
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Provider Business Mailing Address
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Address Line | 240 W 18TH ST
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City | HORTON
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State | KS
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Zip | 66439-1245
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Country | US
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Telephone | 785-486-2642
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Fax | 785-486-2842
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Authorized Official
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Title or Position | CEO
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Name | MR. DALE A. WHITE
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Credential |
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Telephone | 785-486-2642
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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 | H-007-002
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License Number State | KS
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