Provider Demographics
NPI:1912966854
Name:THE CHILDREN'S CLINIC OF MIAMI COUNTY, L.L.C.
Entity Type:Organization
Organization Name:THE CHILDREN'S CLINIC OF MIAMI COUNTY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-294-2482
Mailing Address - Street 1:201 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-3520
Mailing Address - Country:US
Mailing Address - Phone:913-294-2482
Mailing Address - Fax:
Practice Address - Street 1:201 N 13TH ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-3520
Practice Address - Country:US
Practice Address - Phone:913-294-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100380060AMedicaid