Provider Demographics
NPI:1689967317
Name:DOCTORS OFFICE LLC
Entity Type:Organization
Organization Name:DOCTORS OFFICE LLC
Other - Org Name:THE DOCTOR'S OFFICE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:BOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-624-0142
Mailing Address - Street 1:11 W PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2081
Mailing Address - Country:US
Mailing Address - Phone:620-624-0142
Mailing Address - Fax:620-624-2660
Practice Address - Street 1:11 W PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2081
Practice Address - Country:US
Practice Address - Phone:620-624-0142
Practice Address - Fax:620-624-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0531584261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care