Provider Demographics
NPI:1417350984
Name:MIDWEST FAMILY HEALTH OF SMITH CENTER LLC
Entity Type:Organization
Organization Name:MIDWEST FAMILY HEALTH OF SMITH CENTER LLC
Other - Org Name:MIDWEST FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-540-7143
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-0608
Mailing Address - Country:US
Mailing Address - Phone:785-540-4143
Mailing Address - Fax:785-540-4314
Practice Address - Street 1:317 E HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-9586
Practice Address - Country:US
Practice Address - Phone:785-282-3333
Practice Address - Fax:785-686-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336L0003X
KS2-137463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148126OtherPK
KS201105930BMedicaid
KS201105930AMedicaid