NPIMap

Organization Active NPI

Muddy Creek Family Clinic LLC

  • Primary Care Clinic/Center
  • Netawaka, KS
National Provider Identifier
1952311318
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0424501 Issued in KS
Legal business name
MUDDY CREEK FAMILY CLINIC LLC
Practice address
200 White Way St
Netawaka, KS 66516-9378
Phone
(785) 933-2000
Fax
(785) 933-2022
NPI assigned
Aug 9, 2006
Last updated
Feb 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael L. Keehn, M.D.NPI 1386610111
Title
Owner
Phone
(785) 933-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0424501 KS Primary

Addresses

Primary practice location

200 White Way St
Netawaka, KS 66516-9378

Mailing address

200 White Way St
Netawaka, KS 66516-9378
Phone (785) 933-2000

Other identifiers 2

IdentifierTypeStateIssuer
0424501OtherKSSTATE LICENSE
DG5340OtherKSMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

200 White Way St
Netawaka, KS 66516
Phone (785) 234-1600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17244/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1952311318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WHITE WAY ST",
            "city": "NETAWAKA",
            "state": "KS",
            "postal_code": "665169378",
            "telephone_number": "785-933-2000",
            "fax_number": "785-933-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WHITE WAY ST",
            "city": "NETAWAKA",
            "state": "KS",
            "postal_code": "665169378",
            "telephone_number": "785-933-2000",
            "fax_number": "785-933-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUDDY CREEK FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "KEEHN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-933-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KS",
            "license": "0424501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0424501",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DG5340",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Netawaka, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.