MEDICARE: DR. CHARLES C GLENDENNING D.O.

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	207Q00000X	Family Medicine Physician	3574	OK
2	207Q00000X	Family Medicine Physician	05-37409	KS
3	208M00000X	Hospitalist Physician	0537409	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285603647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C GLENDENNING D.O.

Provider Business Mailing Address
First Line	:	650 HUEBNER ROAD
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4030
Country	:	US
Telephone Number	:	785-239-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 HUEBNER ROAD
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4144
Country	:	US
Telephone Number	:	785-239-3627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	06/26/2023

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Directions to “ DR. CHARLES C GLENDENNING D.O.” Practice Location

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