Provider Demographics
NPI:1548361538
Name:CLEARWATER FAMILY PRACTICE PA
Entity type:Organization
Organization Name:CLEARWATER FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:PAPISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-584-2055
Mailing Address - Street 1:101 E ROSS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-7824
Mailing Address - Country:US
Mailing Address - Phone:620-584-2055
Mailing Address - Fax:620-584-2032
Practice Address - Street 1:101 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7824
Practice Address - Country:US
Practice Address - Phone:620-584-2055
Practice Address - Fax:620-584-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0518527261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
111132Medicare ID - Type Unspecified