Provider Demographics
NPI:1154504421
Name:JOHN A BUIE, M.D. P.C.
Entity Type:Organization
Organization Name:JOHN A BUIE, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-4946
Mailing Address - Street 1:1411 W 15TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2285
Mailing Address - Country:US
Mailing Address - Phone:620-624-4946
Mailing Address - Fax:
Practice Address - Street 1:1411 W 15TH ST STE 302
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2285
Practice Address - Country:US
Practice Address - Phone:620-624-4946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01674208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111382OtherBLUE CROSS/BLUE SHEILD
KS200538650AMedicaid
KS200538650AMedicaid