Provider Demographics
NPI:1992420111
Name:AMBERWELL ATCHISON ASSOCIATION
Entity type:Organization
Organization Name:AMBERWELL ATCHISON ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-367-2131
Mailing Address - Street 1:800 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9204
Mailing Address - Country:US
Mailing Address - Phone:913-367-7300
Mailing Address - Fax:
Practice Address - Street 1:380 LIMIT ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4525
Practice Address - Country:US
Practice Address - Phone:913-637-7300
Practice Address - Fax:913-674-2030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBERWELL ATCHISON ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-10
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health