Organization
SPORTS MEDICINE AND ORTHOPEDIC CLINIC OF COWLEY CO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERYL G FULLEN MD (MEMBER/MANAGER/OWNER)
(620) 222-6210
Entity
Organization
Contact information
Practice address
1305 E 5TH AVE, WINFIELD, KS 67156-2406
(620) 222-6210
Mailing address
1305 E 5TH AVE, WINFIELD, KS 67156-2406
(620) 222-6210
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
4-16478
KS
Other
Enumeration date
06/08/2015
Last updated
06/08/2015
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