Pamela J Black
Individual provider Active NPI Contractor · Minneapolis, KS
NPI 1891243622 · NPPES record last updated Sep 21, 2016
Key facts
- NPI
- 1891243622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 14-00129 (KS)
- Practice address
- 903 N 3Rd Ave
Minneapolis, KS 67467-1705 - Phone
- (785) 224-5810
- NPI assigned
- Sep 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14-00129 | KS | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enterprise Community Nursing Home Inc. | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 14-00129 | KS | Yes |
Addresses
Primary practice location
903 N 3Rd Ave
Minneapolis, KS 67467-1705
Mailing address
903 N 3Rd Ave
Minneapolis, KS 67467-1705
Phone (785) 224-5810
Other providers in Minneapolis, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.