Unknown Individual – Family Medicine Physician, NPI 1104809706
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2016-10-20. Reason: License revocation, suspension, or surrender.
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
PO BOX 956
1902 S HWY 59
PARSONS, KS 673570956
Phone: (620) 421-4880
Fax: (620) 421-9544
Type: Mailing
1902 S US HIGHWAY 59
PARSONS, KS 673574948
Phone: (620) 421-4880
Fax: (620) 421-9544
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 67357)
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