MEDICARE: CENTRAL CARE PA

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	261QX0203X	Radiation Oncology Clinic/Center
2	207RX0202X	Medical Oncology Physician

General Provider Information

NPI Number	:	1487253050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CARE PA

Provider Business Mailing Address
First Line	:	2337 E CRAWFORD ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3713
Country	:	US
Telephone Number	:	785-823-0633
Fax Number	:	785-823-0658

Provider Business Practice Location Address
First Line	:	3550 S 4TH ST STE 282
Second Line	:
City	:	LEAVENWORTH
State	:	KS
Zip	:	66048-5160
Country	:	US
Telephone Number	:	913-318-7821
Fax Number	:	833-834-7630

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	STACY CLOYD
Credential	:
Telephone Number	:	785-823-0633

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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Directions to “CENTRAL CARE PA ” Practice Location

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