Provider Demographics
NPI:1376648907
Name:BELLEVILLE MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:BELLEVILLE MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-527-2217
Mailing Address - Street 1:2337 G ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2463
Mailing Address - Country:US
Mailing Address - Phone:785-527-2217
Mailing Address - Fax:785-527-5929
Practice Address - Street 1:2337 G ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2463
Practice Address - Country:US
Practice Address - Phone:785-527-2217
Practice Address - Fax:785-527-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003761Medicare ID - Type Unspecified