Organization
PRAIRIE GYNECOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY C SHORT MD (CHAIRMAN, BOARD OF DIRECTORS)
(316) 305-2330
Entity
Organization
Contact information
Practice address
12115 E 21ST ST N, STE 107, WICHITA, KS 67206-3567
(316) 305-2093
Mailing address
13716 E MAINSGATE ST, WICHITA, KS 67228-8049
(316) 305-2093
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0433994
KS
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
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