Provider Demographics
NPI:1770616252
Name:WESTERN PLAINS PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:WESTERN PLAINS PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:112 W ROSS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7219
Mailing Address - Country:US
Mailing Address - Phone:620-227-5334
Mailing Address - Fax:620-227-5212
Practice Address - Street 1:112 W ROSS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7219
Practice Address - Country:US
Practice Address - Phone:620-227-5334
Practice Address - Fax:620-227-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432750208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200584680AMedicaid
KS200584680AMedicaid