Organization
PANACEA FAMILY MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERDON W PARHAM M.D. (OWNER)
(620) 432-5588
Entity
Organization
Contact information
Practice address
629 S PLUMMER AVE, CHANUTE, KS 66720-1928
(620) 432-5588
(620) 432-5593
Mailing address
PO BOX 843, CHANUTE, KS 66720-0843
(620) 432-5588
(620) 432-5593
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
KS
261QR1300X
Rural Health Clinic/Center
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000111208
BLUE CROSS GROUP
KS
01
—
111208
WPS MEDICARE GROUP NUMBER
KS
01
—
17-8977
RURAL HEALTH CLINIC PTAN
KS
01
—
DE1499
RR MEDICARE GROUP NUMBER
KS
Enumeration date
05/30/2006
Last updated
03/06/2013
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