Organization
WICHITA PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI LARISON MD (OWNER)
(316) 448-8339
Entity
Organization
Contact information
Practice address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
(316) 221-7149
Mailing address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
(316) 221-7149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
07/11/2018
Last updated
01/25/2021
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