Provider Demographics
NPI:1679791933
Name:BARBARA JEAN L OTTLEY MD LLC
Entity type:Organization
Organization Name:BARBARA JEAN L OTTLEY MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA-JEAN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:OTTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-628-7600
Mailing Address - Street 1:2740 THUNDERBIRD DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1403
Mailing Address - Country:US
Mailing Address - Phone:785-623-8722
Mailing Address - Fax:785-628-7601
Practice Address - Street 1:2740 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1403
Practice Address - Country:US
Practice Address - Phone:785-623-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
KS25115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100172360BMedicaid
KS101747OtherBLUE CROSS BLUE SHIELD
KS110739Medicare ID - Type UnspecifiedMEDICARE NUMBER
KS101747OtherBLUE CROSS BLUE SHIELD