| 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 |