Provider Demographics
NPI:1982876512
Name:KIMBALL, ROSS M (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:887-779-1708
Mailing Address - Fax:
Practice Address - Street 1:312 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1333
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:785-448-3091
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200733670CMedicaid
KS110135017Medicare PIN
KS200733670CMedicaid