Provider Demographics
NPI:1437424587
Name:CANDLEWOOD MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:CANDLEWOOD MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMMARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-539-0800
Mailing Address - Street 1:3260 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2157
Mailing Address - Country:US
Mailing Address - Phone:785-539-0800
Mailing Address - Fax:785-539-0811
Practice Address - Street 1:3260 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2157
Practice Address - Country:US
Practice Address - Phone:785-539-0800
Practice Address - Fax:785-539-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059254Medicare PIN
KSF67470Medicare UPIN