Provider Demographics
NPI:1598903874
Name:LIFE CENTER CLINIC
Entity Type:Organization
Organization Name:LIFE CENTER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:TOON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:620-804-2691
Mailing Address - Street 1:112 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3104
Mailing Address - Country:US
Mailing Address - Phone:620-804-2691
Mailing Address - Fax:
Practice Address - Street 1:112 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-3104
Practice Address - Country:US
Practice Address - Phone:620-804-2691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45341261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty