Provider Demographics
NPI:1750498689
Name:INZERILLO FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:INZERILLO FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:INZERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-749-0333
Mailing Address - Street 1:3320 CLINTON PARKWAY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2629
Mailing Address - Country:US
Mailing Address - Phone:785-749-0333
Mailing Address - Fax:785-749-4559
Practice Address - Street 1:3320 CLINTON PARKWAY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2629
Practice Address - Country:US
Practice Address - Phone:785-749-0333
Practice Address - Fax:785-749-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0516222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB91181Medicare UPIN
KS110890Medicare ID - Type UnspecifiedGROUP
KS102759Medicare ID - Type UnspecifiedINDIVIDUAL