Provider Demographics
NPI:1467452904
Name:SLOMKA, JERZY (MD)
Entity Type:Individual
Prefix:
First Name:JERZY
Middle Name:
Last Name:SLOMKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N AYLWARD AVE
Mailing Address - Street 2:PO BOX 103
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-2541
Mailing Address - Country:US
Mailing Address - Phone:785-472-3111
Mailing Address - Fax:785-472-5731
Practice Address - Street 1:1602 N AYLWARD AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-2541
Practice Address - Country:US
Practice Address - Phone:785-472-3111
Practice Address - Fax:785-472-5731
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25637207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS058327OtherBLUE CROSS BLUE SHIELD
KS100177140CMedicaid
KS060676OtherBCBS
KS100177140DMedicaid
KS622680OtherFIRST GUARD
KS622682OtherFIRSTGUARD
KS058327Medicare PIN
KS110224138Medicare PIN
KS060676OtherBCBS
KS622680OtherFIRST GUARD
KS100177140DMedicaid