Organization
COFFEYVILLE DOCTORS CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C. LIN M.D. (PRESIDENT)
(620) 251-7500
Entity
Organization
Contact information
Practice address
801 W 8TH ST, COFFEYVILLE, KS 67337-4109
(620) 251-7500
(620) 252-1715
Mailing address
801 W 8TH ST, P O BOX 1057, COFFEYVILLE, KS 67337-4109
(620) 251-7500
(620) 252-1715
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003973
BLUE CROSS/BLUE SHIELD
—
05
—
100088520A
—
KS
05
—
100722430A
—
OK
Enumeration date
09/21/2006
Last updated
02/28/2008
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