Provider Demographics
NPI:1093827511
Name:MINOR MED PA
Entity Type:Organization
Organization Name:MINOR MED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-272-4000
Mailing Address - Street 1:1119 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1999
Mailing Address - Country:US
Mailing Address - Phone:785-272-4000
Mailing Address - Fax:785-272-0894
Practice Address - Street 1:1119 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1999
Practice Address - Country:US
Practice Address - Phone:785-272-4000
Practice Address - Fax:785-272-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center