Organization Name: | DR JAMES GARDNER INTERNAL MEDICINE |
NPI Number: | 1013315209 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES DIXON GARDNER (CEO) |
Mailing Address: | 1133 College Ave Suite D200 Manhattan |
State: | KS US |
Postal Code: | 665022770 |
Phone Number: | 7855374940 |
Fax Number: | 7855370836 |
NPI Enumeration Date: | 12/20/2014 |
NPI Last Update Date: | 12/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 0416479 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |