MEDICARE: MILFORD FAMILY PRACTICE

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

General Provider Information

NPI Number	:	1831779289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILFORD FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	PO BOX 186
Second Line	:
City	:	MILFORD
State	:	KS
Zip	:	66514-0186
Country	:	US
Telephone Number	:	785-463-3333
Fax Number	:	785-463-3343

Provider Business Practice Location Address
First Line	:	103 SMITH ST
Second Line	:
City	:	MILFORD
State	:	KS
Zip	:	66514-5049
Country	:	US
Telephone Number	:	785-463-3333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANA CHRISTINE ROETHER
Credential	:	NP
Telephone Number	:	785-463-3333

Provider Enumeration Date	:	04/10/2021
Last Update Date	:	04/10/2021

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Directions to “MILFORD FAMILY PRACTICE ” Practice Location

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