Provider Demographics
NPI:1932292273
Name:DR. SHARON MITCHELL'S MEDICAL CLINIC
Entity Type:Organization
Organization Name:DR. SHARON MITCHELL'S MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-0604
Mailing Address - Street 1:13 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2762
Mailing Address - Country:US
Mailing Address - Phone:620-624-0604
Mailing Address - Fax:620-624-1148
Practice Address - Street 1:13 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2762
Practice Address - Country:US
Practice Address - Phone:620-624-0604
Practice Address - Fax:620-624-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427259291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100572Medicare PIN