Provider Demographics
NPI:1407880776
Name:FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS PA
Other - Org Name:THE FAMILY PHYSICIANS, P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-237-4621
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MORAN
Mailing Address - State:KS
Mailing Address - Zip Code:66755-0158
Mailing Address - Country:US
Mailing Address - Phone:620-237-4621
Mailing Address - Fax:620-237-4402
Practice Address - Street 1:304 N CEDAR
Practice Address - Street 2:
Practice Address - City:MORAN
Practice Address - State:KS
Practice Address - Zip Code:66755
Practice Address - Country:US
Practice Address - Phone:620-237-4621
Practice Address - Fax:620-237-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178970OtherRHC-RIVERBEND
KS1551OtherBLUE CROSS RHC
KS178970Medicare Oscar/Certification