Provider Demographics
NPI:1285814483
Name:FAMILY MEDCENTERS, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDCENTERS, P.A.
Other - Org Name:HAYSVILLE FAMILY MEDCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:NIEDEREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-788-6963
Mailing Address - Street 1:1425 W GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1269
Mailing Address - Country:US
Mailing Address - Phone:316-858-4165
Mailing Address - Fax:316-858-4169
Practice Address - Street 1:1425 W GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1269
Practice Address - Country:US
Practice Address - Phone:316-858-4165
Practice Address - Fax:316-858-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1320200008Medicare NSC