Basic Information
| Provider Information | |||||||||
| NPI: | 1750770103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED METHODIST WESTERN KANSAS MEXICAN AMERICAN MINISTRIES, INC. | ||||||||
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| OtherOrganizationName: | UNITED METHODIST MEXICAN AMERICAN MINISTRIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 SAINT JOHN ST | ||||||||
| Address2: | P.O. BOX 766 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6207084463 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679013218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206240463 | ||||||||
| FaxNumber: | 6206247313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2015 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6202751766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
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 | 100314080 | 05 | KS | MEDICAID |