Provider Demographics
NPI:1669861019
Name:UNITED METHODIST WESTERN KANSAS MEXICAN AMERICAN MINISTRIES,INC.
Entity Type:Organization
Organization Name:UNITED METHODIST WESTERN KANSAS MEXICAN AMERICAN MINISTRIES,INC.
Other - Org Name:GENESIS FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-275-1766
Mailing Address - Street 1:712 SAINT JOHN ST
Mailing Address - Street 2:P.O. BOX 766
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5128
Mailing Address - Country:US
Mailing Address - Phone:620-275-1766
Mailing Address - Fax:620-708-4463
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2519
Practice Address - Country:US
Practice Address - Phone:620-424-1580
Practice Address - Fax:620-271-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100314080Medicaid