=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962558395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 03/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 N WOODLAWN BLVD SUITE A
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-788-3741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1410 N WOODLAWN BLVD SUITE A
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-788-3741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. MARK NEIL VINZANT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 316-788-3741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 0417161
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------