MEDICARE: WHEATLAND HEALTH CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	45025	KS

General Provider Information

NPI Number	:	1225076854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEATLAND HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	224 W RAILROAD ST
Second Line	:	PO BOX 67
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9458
Country	:	US
Telephone Number	:	785-582-5400
Fax Number	:	785-582-5406

Provider Business Practice Location Address
First Line	:	224 W RAILROAD ST
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9458
Country	:	US
Telephone Number	:	785-582-5400
Fax Number	:	785-582-5406

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MS. SHERRY SUE RICKEL
Credential	:	ARNP-C
Telephone Number	:	785-582-5400

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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