Provider Demographics
NPI:1851325773
Name:THE FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:THE FAMILY PHYSICIANS PA
Other - Org Name:FAMILY PHYSICIANS P A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-3115
Mailing Address - Street 1:1408 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3004
Mailing Address - Country:US
Mailing Address - Phone:620-365-3115
Mailing Address - Fax:620-365-7717
Practice Address - Street 1:1408 EAST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-4402
Practice Address - Country:US
Practice Address - Phone:620-365-3115
Practice Address - Fax:620-365-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS178969261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100215590BMedicaid
KS1550OtherBLUE CROSS RHC
KS178969OtherRURAL HEALTH IDENTIFICATION
17D0450573OtherCLIA WAIVER