Provider Demographics
NPI:1215958962
Name:ROOKS COUNTY MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:ROOKS COUNTY MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-425-6417
Mailing Address - Street 1:623 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-1966
Mailing Address - Country:US
Mailing Address - Phone:785-425-6417
Mailing Address - Fax:785-425-6138
Practice Address - Street 1:129 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:KENSINGTON
Practice Address - State:KS
Practice Address - Zip Code:66951
Practice Address - Country:US
Practice Address - Phone:785-425-6417
Practice Address - Fax:785-425-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00306363A00000X
KS05-28153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS080179741OtherRAILROAD MEDICARE
KS100429910AMedicaid
KS110843Medicare ID - Type Unspecified
KS080179741OtherRAILROAD MEDICARE
KS178990Medicare Oscar/Certification