Organization Name: | COFFEYVILLE FAMILY PRACTICE CLINIC, P.A. |
NPI Number: | 1487080800 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES LEROY CHRISTENSEN (OWNER/PRESIDENT/PHYSICIAN) |
Mailing Address: | 1318 W 11th St Coffeyville |
State: | KS US |
Postal Code: | 673373608 |
Phone Number: | 6206886373 |
Fax Number: | 6206886313 |
NPI Enumeration Date: | 09/17/2013 |
NPI Last Update Date: | 09/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |