Provider Demographics
NPI:1255856258
Name:HEART OF KANSAS FAMILY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HEART OF KANSAS FAMILY HEALTH CARE, INC.
Other - Org Name:STAFFORD CLINIC SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO
Authorized Official - Prefix:
Authorized Official - First Name:JYL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-792-5700
Mailing Address - Street 1:1905 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2502
Mailing Address - Country:US
Mailing Address - Phone:620-792-5700
Mailing Address - Fax:620-792-5742
Practice Address - Street 1:412 GRAND AVE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:KS
Practice Address - Zip Code:67578-2010
Practice Address - Country:US
Practice Address - Phone:620-792-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART OF KANSAS FAMILY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-10
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)