Organization
WICHITA MEDICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN M HERNANDEZ (PRACTICE MANAGER)
(316) 686-7117
Entity
Organization
Contact information
Practice address
347 S LAURA ST, WICHITA, KS 67211
(316) 686-7117
(316) 686-2679
Mailing address
347 S. LAURA ST., WICHITA, KS 67211-1518
(316) 686-7117
(316) 686-2679
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
19204
KS
363LG0600X
Gerontology Nurse Practitioner
44906
KS
363LG0600X
Gerontology Nurse Practitioner
74898
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016291
BCBS OF KANSAS
KS
05
—
100004190A
—
KS
01
—
CN3326
RAILROAD MEDICARE
KS
Enumeration date
05/16/2006
Last updated
10/01/2021
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