Healthcare Provider Details

I. General information

NPI: 1942380100
Provider Name (Legal Business Name): MEDICAL CONSULTANTS OF PITTSBURG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WILLARD
FRONTENAC KS
66763-2120
US

IV. Provider business mailing address

PO BOX 1023
FRONTENAC KS
66763-1023
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-8849
  • Fax: 620-231-8847
Mailing address:
  • Phone: 620-231-8849
  • Fax: 620-231-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45744
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45744
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number05-25406
License Number StateKS

VIII. Authorized Official

Name: REBECCA LIGHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-231-3000