Organization
MEDICAL CONSULTANTS OF PITTSBURG, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA LIGHT (ADMINISTRATOR)
(620) 231-3000
Entity
Organization
Contact information
Practice address
608 WILLARD, FRONTENAC, KS 66763-2120
(620) 231-8849
(620) 231-8847
Mailing address
PO BOX 1023, FRONTENAC, KS 66763-1023
(620) 231-8849
(620) 231-8847
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05-25406
KS
363L00000X
Nurse Practitioner
45744
KS
363LF0000X
Family Nurse Practitioner
45744
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110994
MEDICARE
KS
01
—
DA9115
GRP RR MEDICARE
KS
Enumeration date
10/16/2006
Last updated
07/07/2016
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