Provider Demographics
NPI:1487712170
Name:CONWAY SPRINGS RHC
Entity type:Organization
Organization Name:CONWAY SPRINGS RHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-896-7313
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058
Mailing Address - Country:US
Mailing Address - Phone:620-896-7313
Mailing Address - Fax:620-896-7121
Practice Address - Street 1:111 W MAIN
Practice Address - Street 2:
Practice Address - City:CONWAY SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:67031
Practice Address - Country:US
Practice Address - Phone:620-456-2411
Practice Address - Fax:620-896-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100244820AMedicaid
D05275Medicare UPIN
KS100244820AMedicaid