Organization
SPECTRUM FAMILY MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHAEDRA M MANN (OFFICE MANAGER)
(316) 462-0460
Entity
Organization
Contact information
Practice address
2020 N TYLER, STE 114, WICHITA, KS 67212-4916
(316) 462-0460
(316) 462-0465
Mailing address
2020 N TYLER, STE 114, WICHITA, KS 67212-4916
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0422366
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112800C
—
KS
Enumeration date
04/25/2006
Last updated
10/05/2017
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