Healthcare Provider Details

I. General information

NPI: 1013155522
Provider Name (Legal Business Name): MSH II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 E ROCKHILL ST STE 406
WICHITA KS
67206-3915
US

IV. Provider business mailing address

7829 E ROCKHILL ST STE 406
WICHITA KS
67206-3915
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-4820
  • Fax:
Mailing address:
  • Phone: 316-440-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JANNIFER SUE TERRY
Title or Position: PRESIDENT
Credential: RN
Phone: 316-440-4820