Healthcare Provider Details

I. General information

NPI: 1043473192
Provider Name (Legal Business Name): TALLGRASS FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 N WILDERNESS CT
WICHITA KS
67226-2140
US

IV. Provider business mailing address

2551 N WILDERNESS CT
WICHITA KS
67226-2140
US

V. Phone/Fax

Practice location:
  • Phone: 316-304-7040
  • Fax:
Mailing address:
  • Phone: 316-304-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LOUIS
Title or Position: MANAGER
Credential: D.O.
Phone: 316-304-7040