Provider Demographics
NPI:1780789636
Name:FEATHERS, MARK EARL (CP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EARL
Last Name:FEATHERS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:627 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5107
Mailing Address - Country:US
Mailing Address - Phone:620-342-0665
Mailing Address - Fax:620-342-7266
Practice Address - Street 1:627 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5107
Practice Address - Country:US
Practice Address - Phone:620-342-0665
Practice Address - Fax:620-342-7266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5173350001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT