Provider Demographics
NPI:1740781848
Name:MEDLEN FAMILY CARE
Entity Type:Organization
Organization Name:MEDLEN FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEDLEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:913-388-3631
Mailing Address - Street 1:23896 W 295TH ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-5305
Mailing Address - Country:US
Mailing Address - Phone:913-388-3631
Mailing Address - Fax:913-871-5168
Practice Address - Street 1:609 BAPTISTE DR STE A
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1334
Practice Address - Country:US
Practice Address - Phone:913-388-3631
Practice Address - Fax:913-871-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care