Coffeyville Family Practice Clinic, P.a.
Organization Active NPI Family Medicine Physician · Coffeyville, KS
NPI 1083689327 · NPPES record last updated Jun 6, 2013
Key facts
- NPI
- 1083689327
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- COFFEYVILLE FAMILY PRACTICE CLINIC, P.A.
- Practice address
- 209 W 7TH St
Coffeyville, KS 67337-4903 - Phone
- (620) 251-1100
- Fax
- (620) 251-7466
- NPI assigned
- Feb 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. James L. Christensen, D.O.
- Title
- Doctor
- Phone
- (620) 251-1100
Subparts reporting this organization as parent 1
Practitioners 7
-
James Leroy Christensen, D.O.
-
Brenda Louise Pursley, RPA-C
-
Jodi Oder, APRN-CNP
-
Stacey L Weil, APRN
-
Melissa J McIntosh, M.D.
-
Sheldon H Genack, MD
-
Sharon J Unger, CCC-A
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0452201 | Coffeyville Family Practice Clinic | Accreditation | Dec 1, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050225000766 | KS | Part B Supplier - Clinic/Group Practice | 2466405725 |
Receives reassigned benefits from 4 practitioners Practice locations: Coffeyville, KS |
National Provider Directory
Locations
209 W 7th St
Ste 1
Coffeyville, KS 67337
209 W 7th St
Ste 2
Coffeyville, KS 67337
1728 Broadway
Ste 5
Hewlett, NY 11557
Phone (516) 887-5788
Interoperability endpoints
- familypractice@cfpc.azalea.phimailbox.com
- provider@cfpc.azalea.phimailbox.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
209 W 7TH St
Coffeyville, KS 67337-4903
Mailing address
PO Box 564
Coffeyville, KS 67337-0564
Phone (620) 251-1100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100722460A | Other | OK | OKLAHOMA MEDICAID |
| 100098700A | Medicaid | KS | |
| 009974 | Other | KS | BLUE CROSS BLUE SHIELD |
Other providers in Coffeyville, KS
- James Leroy Christensen
- McKenzie Clay
- Coffeyville Chiropractic
- Coffeyville Doctors Clinic P a
- Coffeyville Emergency Physicians, LLC
- Coffeyville Family Practice Clinic, P.a.
- Coffeyville Optic Shop LLC
- Coffeyville Orthopaedics, PA
- Coffeyville Regional Medical Center Inc
- Coffeyville Regional Medical Center Inc
All providers in Coffeyville, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.