Provider Demographics
NPI:1225076854
Name:WHEATLAND HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:WHEATLAND HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-C
Authorized Official - Phone:785-582-5400
Mailing Address - Street 1:224 W RAILROAD ST
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9458
Mailing Address - Country:US
Mailing Address - Phone:785-582-5400
Mailing Address - Fax:785-582-5406
Practice Address - Street 1:224 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:KS
Practice Address - Zip Code:66539-9458
Practice Address - Country:US
Practice Address - Phone:785-582-5400
Practice Address - Fax:785-582-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45025261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service