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Organization

OHAEBOSIM MEDICAL CLINIC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LINUS C OHAEBOSIM DO (OWNER PRESIDENT)
(316) 681-1901
Entity
Organization

Contact information

Practice address
2810 E 21ST STREET, WICHITA, KS 67214-2252
(316) 681-1901
(316) 618-7362
Mailing address
2810 E 21ST STREET, WICHITA, KS 67214-2252
(316) 681-1901
(316) 618-7362

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0516911
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100098690A
KS
01
4083832
AETNA
01
49202
BLUE SHIELD
KS
01
614790
FIRST GUARD
01
693
PHS
KS
Enumeration date
11/20/2006
Last updated
12/21/2011
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