Organization
HILLSIDE MEDICAL OFFICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID A GORDON CPA (MANAGER)
(316) 685-1381
Entity
Organization
Contact information
Practice address
855 N HILLSIDE ST, WICHITA, KS 67214-4913
(316) 685-1381
Mailing address
855 N HILLSIDE ST, WICHITA, KS 67214-4913
(316) 685-1381
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087950A
—
KS
01
—
16399
BC/BS GROUP NUMBER
KS
Enumeration date
04/03/2006
Last updated
06/18/2009
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