Individual
GREGORY MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
929 N SAINT FRANCIS ST, WICHITA, KS 67214-3821
(800) 374-5326
(800) 374-7656
Mailing address
1827 N NORTHWEST PKWY, WICHITA, KS 67212-1485
(316) 773-3646
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54170
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043135
BCBS OF KS
KS
05
—
100250150B
—
KS
01
—
430031936
RR MEDICARE GROUP CQ2307
KS
Enumeration date
05/25/2006
Last updated
11/09/2012
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