Provider Demographics
NPI:1508060864
Name:AUGUSTA FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:AUGUSTA FAMILY PRACTICE, PA
Other - Org Name:AUGUSTA RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-201-6711
Mailing Address - Street 1:1306 STATE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-1126
Mailing Address - Country:US
Mailing Address - Phone:316-775-9191
Mailing Address - Fax:316-775-0348
Practice Address - Street 1:1306 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1126
Practice Address - Country:US
Practice Address - Phone:316-775-9191
Practice Address - Fax:316-775-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D0970229261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100359330BMedicaid