Organization
FAMILY MEDCENTERS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID W. NIEDEREE M.D. (PRESIDENT)
(316) 788-6963
Entity
Organization
Contact information
Practice address
1101 N ROCK RD, DERBY, KS 67037-3735
(316) 788-6963
(316) 788-5373
Mailing address
1101 N ROCK RD, DERBY, KS 67037-3735
(316) 788-6963
(316) 788-5373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110501
BC/BS
KS
01
—
CG1679
MEDICARE RAILROAD
KS
Enumeration date
05/21/2006
Last updated
10/25/2007
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