Provider Demographics
NPI:1548813520
Name:SOUTH CENTRAL KANSAS CLINIC LLC
Entity type:Organization
Organization Name:SOUTH CENTRAL KANSAS CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-441-5900
Mailing Address - Street 1:6403 PATTERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-5701
Mailing Address - Country:US
Mailing Address - Phone:620-447-5711
Mailing Address - Fax:620-441-5891
Practice Address - Street 1:6403 PATTERSON PKWY
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-5701
Practice Address - Country:US
Practice Address - Phone:620-447-5711
Practice Address - Fax:620-441-5891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL KANSAS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty