# MARIA MEDICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Med-Ped Clinic of Wichita
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497126585
- **Authorized official:** MANSOOR TAHIR PA (ADMINISTRATOR)
- **Authorized official phone:** (316) 440-2712

## Contact information

- **Practice address:** 9415 E HARRY ST STE 202, WICHITA, KS 67207-5076
- **Practice address phone:** (316) 691-0309
- **Practice address fax:** (316) 691-0881
- **Mailing address:** 9415 E HARRY ST STE 202, WICHITA, KS 67207-5076
- **Mailing address phone:** (316) 691-0309
- **Mailing address fax:** (316) 691-0881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/14/2015
- **Last updated:** 10/14/2015