Provider Demographics
NPI:1932164050
Name:OVERBROOK FAMILY HEALTH CLINIC INC
Entity type:Organization
Organization Name:OVERBROOK FAMILY HEALTH CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARNP FAMILY PRACTICE
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:GENELLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:785-665-3055
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:223 MAPLE ST
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524
Mailing Address - Country:US
Mailing Address - Phone:785-665-3055
Mailing Address - Fax:785-665-3056
Practice Address - Street 1:223 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OVERBROOK
Practice Address - State:KS
Practice Address - Zip Code:66524
Practice Address - Country:US
Practice Address - Phone:785-665-3055
Practice Address - Fax:785-665-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6723OtherPHC
160997OtherBCBS CLINIC
160997OtherBCBS CLINIC
6723OtherPHC
160997OtherBCBS CLINIC