Healthcare Provider Details

I. General information

NPI: 1326561747
Provider Name (Legal Business Name): M AND P HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N STE 2200-2
WICHITA KS
67226-2322
US

IV. Provider business mailing address

8100 E 22ND ST N STE 2200-2
WICHITA KS
67226-2322
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-8383
  • Fax: 316-440-8163
Mailing address:
  • Phone: 316-440-8383
  • Fax: 316-440-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number05-25859
License Number StateKS

VIII. Authorized Official

Name: LINDA M GOODSON
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 316-440-8383