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General NPI Number Information
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NPI Number | 1497829261
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Entity Type | Organization
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Legal Business Name | OHAEBOSIM MEDICAL CLINIC INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 2810 E 21ST STREET
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City | WICHITA
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State | KS
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Zip | 67214-2252
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Country | US
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Telephone | 316-681-1901
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Fax | 316-618-7362
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Provider Business Mailing Address
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Address Line | 2810 E 21ST STREET
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City | WICHITA
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State | KS
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Zip | 67214-2252
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Country | US
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Telephone | 316-681-1901
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Fax | 316-618-7362
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. LINUS C OHAEBOSIM
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Credential | DO
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Telephone | 316-681-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0516911
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License Number State | KS
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