Provider Demographics
NPI:1114041035
Name:LYNDON FAMILY HEALTH CARE CLINIC
Entity Type:Organization
Organization Name:LYNDON FAMILY HEALTH CARE CLINIC
Other - Org Name:LYNDON FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:785-478-9625
Mailing Address - Street 1:PO BOX 4795
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-0795
Mailing Address - Country:US
Mailing Address - Phone:785-478-9625
Mailing Address - Fax:785-271-4392
Practice Address - Street 1:1128 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2020
Practice Address - Country:US
Practice Address - Phone:785-478-9625
Practice Address - Fax:785-271-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44473261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110808OtherKS BCBS
CK3569OtherMEDICARE RAILROAD
KS200258580AMedicaid
CK3569OtherMEDICARE RAILROAD
KS110808Medicare PIN