Healthcare Provider Details

I. General information

NPI: 1871774919
Provider Name (Legal Business Name): PREFERRED MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 S BLUFFVIEW DR STE 102
WICHITA KS
67218-3039
US

IV. Provider business mailing address

PO BOX 764
WICHITA KS
67201-0764
US

V. Phone/Fax

Practice location:
  • Phone: 316-683-5556
  • Fax: 316-683-5479
Mailing address:
  • Phone: 316-683-5556
  • Fax: 316-683-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology 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