Healthcare Provider Details

I. General information

NPI: 1316952070
Provider Name (Legal Business Name): PREFERRED MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S WASHINGTON AVE
IOLA KS
66749-3256
US

IV. Provider business mailing address

401 S WASHINGTON AVE
IOLA KS
66749-3256
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-6933
  • Fax: 620-365-8126
Mailing address:
  • Phone: 620-365-6933
  • Fax: 620-365-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD J HETT
Title or Position: DO/MANAGING PARTNER
Credential:
Phone: 620-365-6933