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General NPI Number Information
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NPI Number | 1588093744
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Entity Type | Organization
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Legal Business Name | PREVENTIVE MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1919 SW 10TH AVE SUITE 22
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City | TOPEKA
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State | KS
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Zip | 66604-1425
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Country | US
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Telephone | 785-783-7779
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Fax | 866-516-1321
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Provider Business Mailing Address
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Address Line | 2921 SW WANAMAKER DR SUITE 107
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City | TOPEKA
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State | KS
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Zip | 66614-5328
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Country | US
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Telephone | 785-215-8777
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Fax | 888-818-3162
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Authorized Official
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Title or Position | DIRECTOR OF MEDICAL BILLING
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Name | MRS. LIZ A SHEPHERD
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Credential |
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Telephone | 785-215-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-25185
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License Number State | KS
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