Provider Demographics
NPI:1942307285
Name:SIMMONS MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:SIMMONS MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-231-9669
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-0999
Mailing Address - Country:US
Mailing Address - Phone:620-231-9669
Mailing Address - Fax:620-231-4585
Practice Address - Street 1:1026 N HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-8100
Practice Address - Country:US
Practice Address - Phone:620-231-9669
Practice Address - Fax:620-231-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24193261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100151280BMedicaid
KS058129OtherBCBS
KS058129Medicare PIN
KS100151280BMedicaid