Provider Demographics
NPI:1295384600
Name:NIOBRARA FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:NIOBRARA FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-434-2622
Mailing Address - Street 1:1210 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-1632
Mailing Address - Country:US
Mailing Address - Phone:785-434-2622
Mailing Address - Fax:785-434-2577
Practice Address - Street 1:1210 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663
Practice Address - Country:US
Practice Address - Phone:785-434-2622
Practice Address - Fax:785-434-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty