Healthcare Provider Details

I. General information

NPI: 1841316619
Provider Name (Legal Business Name): PREFERRED MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N MAIN
GODDARD KS
67052
US

IV. Provider business mailing address

PO BOX 764
WICHITA KS
67201-0764
US

V. Phone/Fax

Practice location:
  • Phone: 316-794-8655
  • Fax: 316-794-2433
Mailing address:
  • Phone: 316-794-8655
  • Fax: 316-794-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD J HETT
Title or Position: PRESIDENT
Credential: MD
Phone: 316-268-8080