Provider Demographics
NPI:1942647151
Name:MIDWEST FAMILY HEALTH OF PLAINVILLE LLC
Entity Type:Organization
Organization Name:MIDWEST FAMILY HEALTH OF PLAINVILLE LLC
Other - Org Name:MIDWEST FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-540-4143
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-0608
Mailing Address - Country:US
Mailing Address - Phone:785-434-4615
Mailing Address - Fax:785-434-4895
Practice Address - Street 1:210 W MILL ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-2227
Practice Address - Country:US
Practice Address - Phone:785-434-4615
Practice Address - Fax:785-434-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201071760AMedicaid
2140541OtherPK