Basic Information
| Provider Information | |||||||||
| NPI: | 1124083373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMCARE, P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674018537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858258221 | ||||||||
| FaxNumber: | 7858250644 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674018537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858258221 | ||||||||
| FaxNumber: | 7858250644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | EHRLICH | ||||||||
| AuthorizedOfficialFirstName: | DARRELL | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7854523255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100302260A | 05 | KS | MEDICAID | 100302260B | 05 | KS | MEDICAID | 100302260C | 05 | KS | MEDICAID | 100302260D | 05 | KS | MEDICAID |