Provider Demographics
NPI:1508865478
Name:OBERLIN MEDICAL ARTS PA
Entity Type:Organization
Organization Name:OBERLIN MEDICAL ARTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-475-2221
Mailing Address - Street 1:902 W COLUMBIA ST
Mailing Address - Street 2:P.O. BOX 110
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2412
Mailing Address - Country:US
Mailing Address - Phone:785-475-2221
Mailing Address - Fax:785-475-3847
Practice Address - Street 1:902 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2412
Practice Address - Country:US
Practice Address - Phone:785-475-2221
Practice Address - Fax:785-475-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100214610AMedicaid
KS100214610AMedicaid