Healthcare Provider Details

I. General information

NPI: 1336123785
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 W 21ST ST N STE 1006B
WICHITA KS
67205-1734
US

IV. Provider business mailing address

7570 W 21ST ST N STE 1006B
WICHITA KS
67205-1734
US

V. Phone/Fax

Practice location:
  • Phone: 316-462-1208
  • Fax: 316-462-1214
Mailing address:
  • Phone: 316-462-1208
  • Fax: 316-462-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY KAY MROZ
Title or Position: PRESIDENT
Credential: MD
Phone: 316-462-1208