Provider Demographics
NPI:1194875443
Name:OBERLIN MEDICAL ARTS, PA
Entity type:Organization
Organization Name:OBERLIN MEDICAL ARTS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-472-2221
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-0110
Mailing Address - Country:US
Mailing Address - Phone:785-472-2221
Mailing Address - Fax:785-475-3847
Practice Address - Street 1:902 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2412
Practice Address - Country:US
Practice Address - Phone:785-475-2221
Practice Address - Fax:785-475-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178904Medicare ID - Type Unspecified