Provider Demographics
NPI:1023089091
Name:WARREN CLINIC
Entity type:Organization
Organization Name:WARREN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO / OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-337-2214
Mailing Address - Street 1:205 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945-0038
Mailing Address - Country:US
Mailing Address - Phone:785-337-2214
Mailing Address - Fax:785-337-2727
Practice Address - Street 1:205 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-0038
Practice Address - Country:US
Practice Address - Phone:785-337-2214
Practice Address - Fax:785-337-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200259900AMedicaid
KS200259900AMedicaid