Provider Demographics
NPI:1033288337
Name:ASHLEY CLINIC, LLC
Entity Type:Organization
Organization Name:ASHLEY CLINIC, LLC
Other - Org Name:ASHLEY CLINIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:620-431-2500
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0946
Mailing Address - Country:US
Mailing Address - Phone:620-431-2500
Mailing Address - Fax:620-431-4418
Practice Address - Street 1:505 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1950
Practice Address - Country:US
Practice Address - Phone:620-431-2500
Practice Address - Fax:620-431-4418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLEY CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080330KMedicaid
KS23411OtherBLUECROSS BLUESHIELD
690005399OtherRAIL ROAD MEDICARE
690005399OtherRAIL ROAD MEDICARE