Provider Demographics
NPI:1215292701
Name:WESTERN PLAINS PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:WESTERN PLAINS PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:112 W ROSS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7219
Mailing Address - Country:US
Mailing Address - Phone:620-371-6446
Mailing Address - Fax:620-371-6223
Practice Address - Street 1:112 W ROSS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7219
Practice Address - Country:US
Practice Address - Phone:620-371-6446
Practice Address - Fax:620-371-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty