Provider Demographics
NPI:1437180155
Name:OSKALOOSA MEDICAL CLINIC AN OPERATING DIVISION OF SFHC
Entity Type:Organization
Organization Name:OSKALOOSA MEDICAL CLINIC AN OPERATING DIVISION OF SFHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEINLICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-945-3263
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:100 E WASHINGTON, STE B
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-0086
Mailing Address - Country:US
Mailing Address - Phone:785-886-4125
Mailing Address - Fax:785-886-4135
Practice Address - Street 1:100 E WASHINGTON, STE B
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-0086
Practice Address - Country:US
Practice Address - Phone:785-886-4125
Practice Address - Fax:785-886-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0521655207Q00000X
KS0517984207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100640830AMedicaid
KS110939Medicare PIN