Provider Demographics
NPI:1548636665
Name:FIRST CARE CLINIC, INC.
Entity type:Organization
Organization Name:FIRST CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-621-4990
Mailing Address - Street 1:105 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3613
Mailing Address - Country:US
Mailing Address - Phone:785-621-4990
Mailing Address - Fax:785-628-8719
Practice Address - Street 1:208 MARC WAGNER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:KS
Practice Address - Zip Code:67671-9589
Practice Address - Country:US
Practice Address - Phone:785-621-4990
Practice Address - Fax:785-628-8719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CARE CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200603010BMedicaid