Provider Demographics
NPI:1023558541
Name:OTTAWA FAMILY PHYSICIANS, CHARTERED
Entity Type:Organization
Organization Name:OTTAWA FAMILY PHYSICIANS, CHARTERED
Other - Org Name:OTTAWA CARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCPHERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-242-1620
Mailing Address - Street 1:1418 S MAIN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3543
Mailing Address - Country:US
Mailing Address - Phone:785-242-1620
Mailing Address - Fax:785-242-5061
Practice Address - Street 1:120 E 19TH ST STE A
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-4300
Practice Address - Country:US
Practice Address - Phone:785-214-4903
Practice Address - Fax:785-214-4622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTTAWA FAMILY PHYSICIANS, CHTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-02
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty