Organization
HERITAGE MEDICAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDOLPH RICHARD WHITELY M.D. (DIRECTOR)
(620) 983-2171
Entity
Organization
Contact information
Practice address
500 W 4TH ST, PEABODY, KS 66866-1103
(620) 983-2171
(620) 983-2575
Mailing address
11881 SW 47TH TER, TOWANDA, KS 67144-9264
(316) 778-2050
(316) 778-2050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-25153
KS
Other
Enumeration date
05/14/2006
Last updated
08/22/2020
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