Provider Demographics
NPI:1457353674
Name:F ALLEN MOORHEAD JR
Entity Type:Organization
Organization Name:F ALLEN MOORHEAD JR
Other - Org Name:F. ALLEN MOORHEAD JR., M.D. FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:620-325-2200
Mailing Address - Street 1:709 MAIN ST
Mailing Address - Street 2:PO BOX 180
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1634
Mailing Address - Country:US
Mailing Address - Phone:620-325-2200
Mailing Address - Fax:620-325-2410
Practice Address - Street 1:709 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1634
Practice Address - Country:US
Practice Address - Phone:620-325-2200
Practice Address - Fax:620-325-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13549261QH0100X
KS178917261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100081690BMedicaid
KS107098OtherBLUE CROSS BLUE SHIELD OF KANSAS
KS1066OtherBC RHC NUMBER
KS1066OtherBC RHC NUMBER
KSB68262Medicare UPIN