Basic Information
| Provider Information | |||||||||
| NPI: | 1548361538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEARWATER FAMILY PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E ROSS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670267824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205842055 | ||||||||
| FaxNumber: | 6205842032 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E ROSS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670267824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205842055 | ||||||||
| FaxNumber: | 6205842032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PAPISH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | IRA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6205842055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 0518527 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.