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General NPI Number Information
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NPI Number | 1417241902
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Entity Type | Organization
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Legal Business Name | PREFERRED MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 1515 S CLIFTON AVE STE. 130
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City | WICHITA
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State | KS
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Zip | 67218-2900
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Country | US
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Telephone | 316-689-5990
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Fax | 316-689-5999
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Provider Business Mailing Address
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Address Line | 1515 S CLIFTON AVE STE. 130
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City | WICHITA
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State | KS
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Zip | 67218-2900
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Country | US
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Telephone | 316-689-5990
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Fax | 316-689-5999
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. SAM WILLIAMS
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Credential |
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Telephone | 316-269-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 04-31473
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License Number State | KS
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