| Desoto Family Practice, Llc | |
| 
					33490 Lexington Ave De Soto KS 66018-8269  | |
| (913) 583-1179 | |
| Not Available | 
| Full Name | Desoto Family Practice, Llc | 
|---|---|
| Speciality | Family Medicine | 
| Location | 33490 Lexington Ave, De Soto, Kansas | 
| Authorized Official Name and Position | Ken Washington (VP) | 
| Authorized Official Contact | 9135831179 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Desoto Family Practice, Llc 33490 Lexington Ave De Soto KS 66018-8269 Ph: (913) 583-1179  | Desoto Family Practice, Llc 33490 Lexington Ave De Soto KS 66018-8269 Ph: (913) 583-1179  | 
| NPI Number | 1407891732 | 
|---|---|
| Provider Enumeration Date | 06/19/2006 | 
| Last Update Date | 08/22/2020 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1407891732 | NPI | - | NPPES | 
| 17436020 | Other | KS | BCBS OF KANSAS | 
| 20-877756-01 | Medicaid | KS | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |