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General NPI Number Information
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NPI Number | 1053740092
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Entity Type | Organization
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Legal Business Name | MARIA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 3161 N ROCK RD
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City | WICHITA
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State | KS
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Zip | 67226-1312
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Country | US
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Telephone | 417-576-6713
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 N GENTRY ST
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City | WICHITA
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State | KS
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Zip | 67208-2053
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Country | US
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Telephone | 417-576-6713
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAMRAH MANSOOR
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Credential | MD
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Telephone | 417-988-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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