Provider Demographics
NPI:1629011994
Name:BEN L. SHORT, M.D., LLC
Entity Type:Organization
Organization Name:BEN L. SHORT, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-221-7669
Mailing Address - Street 1:1230 E 6TH AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3143
Mailing Address - Country:US
Mailing Address - Phone:620-221-7669
Mailing Address - Fax:620-221-7609
Practice Address - Street 1:1230 E 6TH AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3143
Practice Address - Country:US
Practice Address - Phone:620-221-7669
Practice Address - Fax:620-221-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110868OtherBC/BS
KS110868OtherBC/BS