Provider Demographics
NPI:1346739851
Name:UNITY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:UNITY MEDICAL CLINIC, LLC
Other - Org Name:TELECLINICUSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-888-9382
Mailing Address - Street 1:1305 N 1100 RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-9613
Mailing Address - Country:US
Mailing Address - Phone:816-888-9382
Mailing Address - Fax:
Practice Address - Street 1:2201 W 25TH ST STE U
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2957
Practice Address - Country:US
Practice Address - Phone:785-371-1307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0537715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty