Provider Demographics
NPI:1962558395
Name:FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:VINZANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-788-3741
Mailing Address - Street 1:1410 N WOODLAWN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2922
Mailing Address - Country:US
Mailing Address - Phone:316-788-3741
Mailing Address - Fax:
Practice Address - Street 1:1410 N WOODLAWN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2922
Practice Address - Country:US
Practice Address - Phone:316-788-3741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016429OtherMEDICARE GROUP #