Provider Demographics
NPI:1891069647
Name:LONG TERM CARE SPECIALISTS
Entity Type:Organization
Organization Name:LONG TERM CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-326-0251
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-0755
Mailing Address - Country:US
Mailing Address - Phone:620-440-8121
Mailing Address - Fax:
Practice Address - Street 1:1323 N A ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4350
Practice Address - Country:US
Practice Address - Phone:620-440-8121
Practice Address - Fax:620-359-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0524781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100233060JMedicaid
KS100233060JMedicaid