Organization
FORT SCOTT FAMILY MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY D KELLENBERGER D.O. (PRESIDENT)
(620) 223-3950
Entity
Organization
Contact information
Practice address
202 STATE ST, SUITE A, FORT SCOTT, KS 66701-2031
(620) 223-3950
(620) 223-1302
Mailing address
202 STATE ST, SUITE A, FORT SCOTT, KS 66701-2031
(620) 223-3950
(620) 223-1302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110645
BLUE CROSS BLUE SHIELD
KS
05
—
2087370801
—
KS
Enumeration date
08/19/2006
Last updated
08/22/2020
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