Organization
COFFEYVILLE FAMILY PRACTICE CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES L. CHRISTENSEN D.O. (DOCTOR)
(620) 251-1100
Entity
Organization
Contact information
Practice address
209 W 7TH ST, COFFEYVILLE, KS 67337-4903
(620) 251-1100
(620) 251-7466
Mailing address
PO BOX 564, COFFEYVILLE, KS 67337-0564
(620) 251-1100
(620) 251-7466
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009974
BLUE CROSS BLUE SHIELD
KS
05
—
100098700A
—
KS
01
—
100722460A
OKLAHOMA MEDICAID
OK
Enumeration date
02/21/2006
Last updated
06/06/2013
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