Healthcare Provider Details

I. General information

NPI: 1164292090
Provider Name (Legal Business Name): PREMONITION HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 S BLUFFVIEW DR STE 210
WICHITA KS
67218-3039
US

IV. Provider business mailing address

1431 S BLUFFVIEW DR STE 210
WICHITA KS
67218-3039
US

V. Phone/Fax

Practice location:
  • Phone: 316-789-6049
  • Fax: 316-867-6365
Mailing address:
  • Phone: 316-789-6049
  • Fax: 316-867-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW L BEZZANT
Title or Position: PRESIDENT
Credential: MD
Phone: 316-789-6049