Organization
TANGLEWOOD FAMILY MEDICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORIANNE NIGHSWONGER (OFFICE MANAGER)
(316) 788-3787
Entity
Organization
Contact information
Practice address
606 MULBERRY RD, DERBY, KS 67037-3532
(316) 788-3787
(316) 788-6930
Mailing address
606 MULBERRY RD, DERBY, KS 67037-3532
(316) 788-3787
(316) 788-6930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00099501
MEDICARE RAILROAD
KS
Enumeration date
09/26/2006
Last updated
10/21/2008
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