Basic Information
| Provider Information | |||||||||
| NPI: | 1407887292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY FALLS MEDICAL CLINIC AN OPERATING DIVISION OF SFHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 216 | ||||||||
| Address2: | 403 SYCAMORE | ||||||||
| City: | VALLEY FALLS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660880216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7859453263 | ||||||||
| FaxNumber: | 7859453902 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | VALLEY FALLS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660881318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7859453263 | ||||||||
| FaxNumber: | 7859453902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEINLICHT | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7859453263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0521655 | KS | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 0517984 | KS | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100640830B | 05 | KS | MEDICAID |