Organization
PREMIER PET IMAGING OF WICHITA INC
Active
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
Update your record
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