Provider Demographics
NPI:1851394555
Name:CLAY CENTER FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:CLAY CENTER FAMILY PHYSICIANS PA
Other - Org Name:LINN FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-632-2181
Mailing Address - Street 1:609 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1564
Mailing Address - Country:US
Mailing Address - Phone:785-632-2181
Mailing Address - Fax:785-632-2309
Practice Address - Street 1:706 3RD ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:KS
Practice Address - Zip Code:66953-9029
Practice Address - Country:US
Practice Address - Phone:785-348-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100002640CMedicaid
KS173855Medicare ID - Type Unspecified