MEDICARE: FAMILY PRACTICE ASSOCIATES OF ULYSSES 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	207Q00000X	Family Medicine Physician	05-27920	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

General Provider Information

NPI Number	:	1316916638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE ASSOCIATES OF ULYSSES LLC

Provider Business Mailing Address
First Line	:	202 W KANSAS AVE
Second Line	:
City	:	ULYSSES
State	:	KS
Zip	:	67880-2034
Country	:	US
Telephone Number	:	620-356-5870
Fax Number	:	620-356-5867

Provider Business Practice Location Address
First Line	:	202 W KANSAS AVE
Second Line	:
City	:	ULYSSES
State	:	KS
Zip	:	67880-2034
Country	:	US
Telephone Number	:	620-356-5870
Fax Number	:	620-356-5867

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DOUG E JOHNSON
Credential	:	DO
Telephone Number	:	620-356-5870

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/03/2010

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Directions to “FAMILY PRACTICE ASSOCIATES OF ULYSSES LLC ” Practice Location

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