Provider Demographics
NPI:1841255437
Name:FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS, LLC
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-225-1650
Mailing Address - Street 1:120 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2131
Mailing Address - Country:US
Mailing Address - Phone:620-225-1650
Mailing Address - Fax:620-227-2505
Practice Address - Street 1:120 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2131
Practice Address - Country:US
Practice Address - Phone:620-225-1650
Practice Address - Fax:620-227-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100388180CMedicaid
KS100388180AMedicaid
KS110630OtherBCBS