Basic Information
| Provider Information | |||||||||
| NPI: | 1871789719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED METHODIST WESTERN KANSAS MEXICAN-AMERICAN MINISTRIES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GENESIS FAMILY HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 766 | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678460766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202717400 | ||||||||
| FaxNumber: | 6207084463 | ||||||||
| Practice Location | |||||||||
| Address1: | 2330 N KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679012372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206240463 | ||||||||
| FaxNumber: | 6206247313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6202717400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | N | Suppliers | Non-Pharmacy Dispensing Site | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | CH07463B | 01 | HRSA OFFICE OF PHARMACY AFFAIRS 340B PROGRAM | OTHER | 100314080E | 05 | KS | MEDICAID |