| Independence Family Medicine | |
|
1415 N Penn Ave Independence KS 67301-2222 | |
| (620) 331-2400 | |
| (620) 331-2405 |
| Full Name | Independence Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1415 N Penn Ave, Independence, Kansas |
| Authorized Official Name and Position | John Gutschenritter (CFO) |
| Authorized Official Contact | 6203258388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Family Medicine Po Box 314 1415 N. Penn Ave Independence KS 67301-0314 Ph: (620) 331-2400 | Independence Family Medicine 1415 N Penn Ave Independence KS 67301-2222 Ph: (620) 331-2400 |
| NPI Number | 1003251802 |
|---|---|
| Provider Enumeration Date | 05/07/2013 |
| Last Update Date | 08/18/2016 |
| Medicare PECOS PAC ID | 2163656208 |
|---|---|
| Medicare Enrollment ID | O20131003000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003251802 | NPI | - | NPPES |
| 012213 | Other | KS | MEDICARE PART B PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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