1518250505 NPI number — ONE BODY FAMILY & FERTILITY CLINIC, LLC

Table of content: (NPI 1518250505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518250505 NPI number — ONE BODY FAMILY & FERTILITY CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE BODY FAMILY & FERTILITY CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518250505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1815
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67402-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S SANTA FE AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-404-1603
Provider Business Practice Location Address Fax Number:
785-823-0575
Provider Enumeration Date:
05/24/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOGAN
Authorized Official First Name:
AMY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICAN - OWNER
Authorized Official Telephone Number:
785-404-1603

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0431120 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)