Healthcare Provider Details

I. General information

NPI: 1700928504
Provider Name (Legal Business Name): PROFESSIONAL MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 SW CLAY ST
TOPEKA KS
66604-3029
US

IV. Provider business mailing address

PO BOX 5956
TOPEKA KS
66605-5956
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-3584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. KEVIN S. WILSON
Title or Position: PRESIDENT
Credential:
Phone: 785-235-3584