Healthcare Provider Details

I. General information

NPI: 1992055669
Provider Name (Legal Business Name): COMFORTCAREINKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W 27TH ST S APT 301
WICHITA KS
67217-3050
US

IV. Provider business mailing address

719 W 27TH ST S APT 301
WICHITA KS
67217-3050
US

V. Phone/Fax

Practice location:
  • Phone: 316-361-6871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateKS

VIII. Authorized Official

Name: MRS. JENNIFER A KRAMER I
Title or Position: CEO
Credential: C.M.A
Phone: 316-361-6871