Provider Demographics
NPI:1992730592
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:D O
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 1:300 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-2505
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:2006-07-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528153207Q00000X
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100429910AMedicaid
KS080179741OtherRAILROAD MEDICARE
KS080179741OtherRAILROAD MEDICARE
KS110843Medicare ID - Type Unspecified
KSH10166Medicare UPIN