Provider Demographics
NPI:1114025137
Name:FAMILY MEDCENTERS, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDCENTERS, P.A.
Other - Org Name:DERBY AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NIEDEREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-788-6963
Mailing Address - Street 1:1101 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3735
Mailing Address - Country:US
Mailing Address - Phone:316-788-6963
Mailing Address - Fax:316-789-5373
Practice Address - Street 1:1101 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3735
Practice Address - Country:US
Practice Address - Phone:316-788-6963
Practice Address - Fax:316-789-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS-087-011261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS112204OtherBC/BS
KS112204OtherBC/BS