Provider Demographics
NPI:1467668780
Name:DEWITT FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:DEWITT FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-241-4477
Mailing Address - Street 1:507 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-5324
Mailing Address - Country:US
Mailing Address - Phone:620-241-4477
Mailing Address - Fax:620-241-2716
Practice Address - Street 1:507 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-5324
Practice Address - Country:US
Practice Address - Phone:620-241-4477
Practice Address - Fax:620-241-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF39140Medicare UPIN