Provider Demographics
NPI:1013902840
Name:MARY MAGATHAN
Entity Type:Organization
Organization Name:MARY MAGATHAN
Other - Org Name:KID-SCREEN, L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RNC, ARNP, CCM
Authorized Official - Phone:620-274-4280
Mailing Address - Street 1:670 B, RD 170
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:KS
Mailing Address - Zip Code:66843
Mailing Address - Country:US
Mailing Address - Phone:620-274-4280
Mailing Address - Fax:620-274-4439
Practice Address - Street 1:670 B, RD 170
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:KS
Practice Address - Zip Code:66843
Practice Address - Country:US
Practice Address - Phone:620-274-4280
Practice Address - Fax:620-274-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1326921-032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100246810AMedicaid
044923OtherBCBS