| Organization Name: | RACY'S MEDICAL CLINIC |
| NPI Number: | 1891054474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDALL KEITH CUNDIFF (OWNER) |
| Mailing Address: | 107 North Main Street Cimarron |
| State: | KS US |
| Postal Code: | 678350646 |
| Phone Number: | 6208554616 |
| Fax Number: | 6208554613 |
| NPI Enumeration Date: | 05/16/2012 |
| NPI Last Update Date: | 05/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 5344884111 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |