MEDICARE: VICKI L GROMALA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1500730	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194888602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI L GROMALA PA

Provider Business Mailing Address
First Line	:	1861 N. ROAD ROAD
Second Line	:	SUITE 105
City	:	WICHITA
State	:	KS
Zip	:	67206-1264
Country	:	US
Telephone Number	:	316-201-1202
Fax Number	:	316-201-1251

Provider Business Practice Location Address
First Line	:	1861 N. ROAD ROAD
Second Line	:	SUITE 105
City	:	WICHITA
State	:	KS
Zip	:	67206-1264
Country	:	US
Telephone Number	:	316-201-1202
Fax Number	:	316-201-1251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/15/2013

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Directions to “ VICKI L GROMALA PA” Practice Location

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