Organization
NORTHWEST KANSAS TECH COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBY ANN HEATWOLE ATC, LAT (HEAD ATHLETIC TRAINER)
(620) 290-4687
Entity
Organization
Contact information
Practice address
1209 HARRISON AVE, GOODLAND, KS 67735-3441
(785) 890-1539
Mailing address
417 BROADWAY, GOODLAND, KS 67735
(785) 890-1539
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
XSB886824257
KS
Other
Enumeration date
11/09/2016
Last updated
11/09/2016
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