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Organization
NORTHEAST KANSAS CENTER FOR HEALTH AND WELLNESS, INC.
Active
Organization
NORTHEAST KANSAS CENTER FOR HEALTH AND WELLNESS, INC.
Active
Other names
Physician Hospital Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE A. WHITE (CEO)
(785) 486-2642
Entity
Organization
Contact information
Practice address
240 W 18TH ST, HORTON, KS 66439-1245
(785) 486-2642
(785) 486-2842
Mailing address
240 W 18TH ST, HORTON, KS 66439-1245
(785) 486-2642
(785) 486-2842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H-007-002
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042154
BLUE SHIELD
KS
01
—
105445
BLUE SHIELD
KS
01
—
161636
BLUE SHIELD
KS
01
—
426980
BLUE SHIELD
KS
01
—
426996
BLUE SHIELD
KS
01
—
664990
FIRST GUARD HEALTH PLAN
KS
01
—
927587
FIRST GUARD HEALTH PLAN
KS
01
—
928432
FIRST GUARD HEALTH PLAN
KS
Enumeration date
06/16/2006
Last updated
08/22/2020
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