Organization
PREMIER PET IMAGING OF WICHITA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE MAHONEY (CHIEF FINANCIAL OFFICER)
(561) 447-0046
Entity
Organization
Contact information
Practice address
500 S MAIN ST, SUITE B, WICHITA, KS 67202-3722
(316) 263-4738
(316) 263-6697
Mailing address
PO BOX 343, WICHITA, KS 67201-0343
(316) 262-2015
(316) 262-0983
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
261Q00000X
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300124391 GRP#CH9838
RR MEDICARE
KS
Enumeration date
04/18/2006
Last updated
10/02/2007
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