Organization
KINGMAN HEALTH CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE ALEXANDER D.O. (PRESIDENT)
(620) 532-5145
Entity
Organization
Contact information
Practice address
701 E A AVE, KINGMAN, KS 67068-1723
(620) 532-5145
(620) 532-2586
Mailing address
701 E A AVE, KINGMAN, KS 67068-1723
(620) 532-5145
(620) 532-2586
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100397910B
—
KS
Enumeration date
08/07/2006
Last updated
09/27/2011
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