Organization
DESOTO FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN WASHINGTON (VP)
(913) 583-1179
Entity
Organization
Contact information
Practice address
33490 LEXINGTON AVE, DE SOTO, KS 66018-8269
(913) 583-1179
Mailing address
33490 LEXINGTON AVE, DE SOTO, KS 66018-8269
(913) 583-1179
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17436020
BCBS OF KANSAS
KS
05
—
20-877756-01
—
KS
Enumeration date
06/19/2006
Last updated
08/22/2020
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