Basic Information
| Provider Information | |||||||||
| NPI: | 1871973586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED METHODIST WESTERN KANSAS MEXICAN AMERICAN MINISTRIES, INC. | ||||||||
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| OtherOrganizationName: | UMMAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 SAINT JOHN ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202717400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11200 LARIAT WAY | ||||||||
| Address2: | |||||||||
| City: | DODGE CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678017328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202717400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6202717400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.