Provider Demographics
NPI:1003164872
Name:SEK PRIMARY CARE ASSOC, LLC
Entity Type:Organization
Organization Name:SEK PRIMARY CARE ASSOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-325-2500
Mailing Address - Street 1:2600 OTTAWA RD STE 101
Mailing Address - Street 2:PO BOX 345
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1897
Mailing Address - Country:US
Mailing Address - Phone:620-325-2500
Mailing Address - Fax:620-325-2550
Practice Address - Street 1:2600 OTTAWA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1897
Practice Address - Country:US
Practice Address - Phone:620-325-2500
Practice Address - Fax:620-325-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-31846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty