Healthcare Provider Details

I. General information

NPI: 1265787071
Provider Name (Legal Business Name): OC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 12/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N CLEVELAND AVE
WICHITA KS
67214-4024
US

IV. Provider business mailing address

PO BOX 8486
WICHITA KS
67208-0486
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-0238
  • Fax: 316-260-5574
Mailing address:
  • Phone: 316-247-0238
  • Fax: 316-260-5574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA087-161
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIGINA PRYOR
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 316-247-0238