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General NPI Number Information
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NPI Number | 1437443488
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 3450 N ROCK RD STE 503
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City | WICHITA
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State | KS
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Zip | 67226-1355
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Country | US
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Telephone | 316-312-0002
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Fax | 316-854-5644
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Provider Business Mailing Address
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Address Line | 3450 N ROCK RD STE 503
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City | WICHITA
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State | KS
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Zip | 67226-1355
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Country | US
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Telephone | 316-312-0002
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Fax | 316-854-5644
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Authorized Official
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Title or Position | CEO
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Name | GREGORY ALEX MELUGIN
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Credential |
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Telephone | 316-312-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 53-76590
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 45062
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-32303
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License Number State | KS
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