Provider Demographics
NPI:1417923780
Name:PARTNERS IN FAMILY CARE LLC
Entity Type:Organization
Organization Name:PARTNERS IN FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ULLOM-MINNICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-345-6322
Mailing Address - Street 1:200 EAST PACK
Mailing Address - Street 2:
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-0640
Mailing Address - Country:US
Mailing Address - Phone:620-345-6322
Mailing Address - Fax:620-345-3038
Practice Address - Street 1:200 E PACK
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-0640
Practice Address - Country:US
Practice Address - Phone:620-345-6322
Practice Address - Fax:620-345-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS460679Medicaid
KS100273280AMedicaid
KS110273OtherBS GROUP ID NUMBER
KS460682Medicaid
KS460682Medicaid