Provider Demographics
NPI:1376723528
Name:FAMILY MEDCENTERS, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDCENTERS, P.A.
Other - Org Name:MULVANE 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 1:1004 SE LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1109
Mailing Address - Country:US
Mailing Address - Phone:316-777-0176
Mailing Address - Fax:316-777-1817
Practice Address - Street 1:1004 SE LOUIS DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1109
Practice Address - Country:US
Practice Address - Phone:316-777-0176
Practice Address - Fax:316-777-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1320200001Medicare NSC