Organization
JERAD WIDMAN
Active
Other names
SPRING HILL FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALI SEELING RN (PRACTICE MANAGER)
(913) 592-2720
Entity
Organization
Contact information
Practice address
22450 S HARRISON ST, SUITE 100, SPRING HILL, KS 66083-8882
(913) 592-2720
(913) 592-2725
Mailing address
22450 S HARRISON ST, SUITE 100, SPRING HILL, KS 66083-8882
(913) 592-2720
(913) 592-2725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
KS0430763
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200300220D
—
KS
01
—
35084012
BLUE CROSS BLUE SHIELD KC
—
Enumeration date
10/03/2007
Last updated
08/16/2017
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